Reducing Antibiotic Use in the Management of Upper Respiratory Infections in the Urgent Care Setting

2.50
Hdl Handle:
http://hdl.handle.net/10755/621839
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Reducing Antibiotic Use in the Management of Upper Respiratory Infections in the Urgent Care Setting
Other Titles:
Use of Antibiotics
Author(s):
Holley, Melissa Jones
Lead Author STTI Affiliation:
Nu Beta
Author Details:
Melissa Jones Holley, DNP, MSN, BSN, APRN, FNP-c, Professional Experience: 2016-present Director, Disease Management and Population Health Carroll Hospital 2008-2016 Director of Clinical Operations/Nurse Practitioner MyCare Express Urgent Care Centers/Carroll Hospital Center My Care Now Eldersburg, MD 2007-2009 Director of Medical Support Patient First Owings Mills, MD 1999-2009 Nurse Practitioner Patient First Perry Hall, MD 1997-1999 Nurse Practitioner York Health Corporation York, PA Responsible for the day to day operations of urgent care facilities in the Maryland area. Duties and accomplishments include the development of policies and procedures designed to improve patient care and flow, improve staffing and retention, and the implementation of effective marketing strategies. (2007-present) Responsible for providing quality, safe and cost effective clinical management to patients requiring urgent care services. (1999-present) Author Summary: Melissa Jones-Holley is a Family Nurse Practitioner currently serving as the Director for Disease Management and Population Health at Carroll Hospital in Westminster, Maryland. She is a recent DNP graduate from Johns Hopkins University School of Nursing and has spent her career providing patient care, improving clinical and administrative processes, and fostering the education of patients, families and Nurse Practitioner students.
Abstract:

Purpose: Upper Respiratory Infections (URIs) are the most common presenting complaint to urgent care centers across the United States. Regardless of etiology or provider specialty, antibiotics are prescribed 60% of the time for the treatment of URIs, contributing to drug resistant respiratory organisms which often provide clinical management challenges for patients and their providers. These practices impact patient outcomes, quality of care, antimicrobial resistance, and economics in community and hospital settings. Chart reviews at a local urgent care company revealed similar practices among providers. Differences in provider type, knowledge base, confidence, practice experiences, and the lack of company adopted treatment guidelines were noted to be probable contributors. As a result, a quality improvement project was implemented to promote quality, evidenced based care in the management of patients with upper respiratory infections.

Methods: A multimodal intervention combining provider consensus meetings, clinical guideline review and development, use of clinical pathways, prescriber feedback and audit, and patient education was implemented at two urgent care centers to reduce the rate of antibiotic prescribing for URIs. Antibiotic prescribing rates for the baseline and intervention periods were obtained through the review of 273 patient charts with diagnoses of URI, nasopharyngitis, bronchitis, and sinusitis for each respective period and compared. Clinical guideline adherence rates were also captured and analyzed for this intervention.

Results: Evaluation of 273 patient encounters with diagnoses of URI, sinusitis and bronchitis during the intervention period demonstrated a 56.8% reduction in the prescribing rate of antibiotics (CI 95%, p <0.00) and an 87.2% rate of compliance with the adopted clinical guidelines (CI 95%, p < 0.00).

Conclusion: Antibiotic prescribing for common URI diagnoses was significantly reduced at two urgent care centers through the implementation of multimodal strategies targeting providers and patients. Such an approach could enhance compliance with URI evidence-based practice guidelines in the outpatient setting resulting in the judicious use of antibiotics.

Keywords:
antibiotic use; upper respiratory infections; urgent care
Repository Posting Date:
14-Jul-2017
Date of Publication:
14-Jul-2017
Other Identifiers:
INRC17E17
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleReducing Antibiotic Use in the Management of Upper Respiratory Infections in the Urgent Care Settingen_US
dc.title.alternativeUse of Antibioticsen
dc.contributor.authorHolley, Melissa Jonesen
dc.contributor.departmentNu Betaen
dc.author.detailsMelissa Jones Holley, DNP, MSN, BSN, APRN, FNP-c, Professional Experience: 2016-present Director, Disease Management and Population Health Carroll Hospital 2008-2016 Director of Clinical Operations/Nurse Practitioner MyCare Express Urgent Care Centers/Carroll Hospital Center My Care Now Eldersburg, MD 2007-2009 Director of Medical Support Patient First Owings Mills, MD 1999-2009 Nurse Practitioner Patient First Perry Hall, MD 1997-1999 Nurse Practitioner York Health Corporation York, PA Responsible for the day to day operations of urgent care facilities in the Maryland area. Duties and accomplishments include the development of policies and procedures designed to improve patient care and flow, improve staffing and retention, and the implementation of effective marketing strategies. (2007-present) Responsible for providing quality, safe and cost effective clinical management to patients requiring urgent care services. (1999-present) Author Summary: Melissa Jones-Holley is a Family Nurse Practitioner currently serving as the Director for Disease Management and Population Health at Carroll Hospital in Westminster, Maryland. She is a recent DNP graduate from Johns Hopkins University School of Nursing and has spent her career providing patient care, improving clinical and administrative processes, and fostering the education of patients, families and Nurse Practitioner students.en
dc.identifier.urihttp://hdl.handle.net/10755/621839-
dc.description.abstract<p><strong>Purpose: </strong><span>Upper Respiratory Infections (URIs) are the most common presenting complaint to urgent care centers across the United States. Regardless of etiology or provider specialty, antibiotics are prescribed 60% of the time for the treatment of URIs, contributing to drug resistant respiratory organisms which often provide clinical management challenges for patients and their providers. These practices impact patient outcomes, quality of care, antimicrobial resistance, and economics in community and hospital settings. Chart reviews at a local urgent care company revealed similar practices among providers. Differences in provider type, knowledge base, confidence, practice experiences, and the lack of company adopted treatment guidelines were noted to be probable contributors. As a result, a quality improvement project was implemented to promote quality, evidenced based care in the management of patients with upper respiratory infections.</span></p> <p><strong>Methods: </strong>A multimodal intervention combining provider consensus meetings, clinical guideline review and development, use of clinical pathways, prescriber feedback and audit, and patient education was implemented at two urgent care centers to reduce the rate of antibiotic prescribing for URIs. Antibiotic prescribing rates for the baseline and intervention periods were obtained through the review of 273 patient charts with diagnoses of URI, nasopharyngitis, bronchitis, and sinusitis for each respective period and compared. Clinical guideline adherence rates were also captured and analyzed for this intervention.</p> <p><strong>Results: </strong>Evaluation of 273 patient encounters with diagnoses of URI, sinusitis and bronchitis during the intervention period demonstrated a 56.8% reduction in the prescribing rate of antibiotics (CI 95%, p <0.00) and an 87.2% rate of compliance with the adopted clinical guidelines (CI 95%, p < 0.00).</p> <p><strong>Conclusion: </strong>Antibiotic prescribing for common URI diagnoses was significantly reduced at two urgent care centers through the implementation of multimodal strategies targeting providers and patients. Such an approach could enhance compliance with URI evidence-based practice guidelines in the outpatient setting resulting in the judicious use of antibiotics.</p>en
dc.subjectantibiotic useen
dc.subjectupper respiratory infectionsen
dc.subjecturgent careen
dc.date.available2017-07-14T13:29:19Z-
dc.date.issued2017-07-14-
dc.date.accessioned2017-07-14T13:29:19Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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