Date of Award

Summer 2022

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Amanda Bullard


April Garrigan, DNP


Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing for URIs. This project aimed to show the efficacy of implementing antimicrobial stewardship guidelines in the urgent care setting to reduce the misuse of antibiotics prescribed for URIs.

Methods: This quality improvement project consisted of a formal educational session provided to healthcare providers in an outpatient urgent/primary care facility regarding appropriate antibiotic prescribing for upper respiratory illnesses based on the Centers for Disease Control and Prevention (CDC) Adult Outpatient Treatment Recommendations. Educational visuals regarding appropriateness of antibiotics (“What’s Got You Sick: Virus or Bacteria?”) were also displayed in patient exam rooms. Chart audits were conducted pre- and post-intervention to assess the occurrence of antibiotic prescribing for upper respiratory tract infections, as well as pre- and post-surveys administered to healthcare providers to evaluate the effectiveness of the formal education session.

Results: Key results included a decrease in the antibiotic prescribing rates for the diagnosis of acute pharyngitis from 74.51% to 59.74% post-intervention (p=.087). A decrease in individual prescribing rates for two providers were noted post-intervention. Provider B’s antibiotic prescribing rate decreased from 90.59% to 73.39%, (p=.002), and provider C’s prescribing rate decreased from 91.38% to 88.24%, (p=.696).

Conclusion: This project stressed the critical need to implement antimicrobial stewardship guidelines in outpatient settings and to offer additional training and resources to healthcare providers to reduce inappropriate antibiotic prescribing

DNP defense approval form.pdf (101 kB)
Manuscript Defense Approval Form



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