Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Dr. Nancy Magnuson DNP


Dr. Elizabeth Merritt DNP

Dr. Jennifer Wessels MD


Purpose: The inappropriate use of antibiotics has led to the development of antimicrobial

resistance which is a severe threat to the public and an increasing global problem. The

Centers for Disease Control and Prevention (CDC) estimates at least two million illnesses

and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States (CDC,

2014). The purpose of this quality improvement (QI) project was to evaluate the

effectiveness of an antibiotic stewardship program (ASP) on urgent care providers'

prescribing on viral respiratory tract infections (RTIs) including the common cold,

pharyngitis, and bronchitis.

Methods: This QI project implemented the CDCs Core Elements of Outpatient

Antibiotic Stewardship Program (CEOASP) into an urgent care setting to determine the

impact it had on inappropriate antibiotic prescribing for viral RTIs. The process will included displaying commitment letters and antibiotic stewardship (ABS) educational posters in each exam room, presented education on ABS, pathophysiology, diagnosis and treatment guidelines on viral RTIs, as well as education on patient communication techniques used with patients. Retrospective electronic medical record review was conducted from 600 randomly selected patients who presented for treatment of RTIs during the evaluation period. The statistical analysis used was Exact McNemar test.

Results: A total of 600 charts, 300 preintervention, and 300 postintervention were evaluated in this study. The overall rate of inappropriate antibiotic prescribing decreased from 21.7% (n = 65) to 8.7% (n = 26), which is a 60% decrease in inappropriate antibiotic prescribing which results in a p < .001%.

Implications for Practice: Implementing the Core Elements of Outpatient ASP is needed to promote ABS and the judicious use of antibiotics in the treatment of the outpatient setting.

OCLC Number