Antibiotic Stewardship in Patients with Viral Upper Respiratory Illness: Improving Quality Measures in Retail Health

BACKGROUND: Millions of people will die from antibiotic-resistant bacterial infections in the next 30 years. Retail health providers are pivotal in this global epidemiological problem.

LOCAL PROBLEM: Setting included 15 retail health clinics operated by Vanderbilt University Medical Center in Middle Tennessee. Project examined provider education, patient engagement, and commitment to antibiotic stewardship, components of the CDC's Core Elements of Outpatient Antibiotic Stewardship framework. Specific aims were that providers would have a significant reduction in the percentage of antibiotics prescribed for viral illness over the study period.

METHODS: Using the Evidence-Based Practice Improvement Model, a Quality Improvement project was implemented to decrease inappropriate antibiotic prescriptions for viral illnesses. Three Plan-Do-Study-Act (PDSA) cycles were used over six weeks to evaluate the project's efficacy.

INTERVENTIONS: Providers were encouraged to commit to antibiotic stewardship voluntarily. Another recommendation was to delay the prescription of antibiotics for viral illnesses until a repeat evaluation was performed in 3-5 days. Provider and medical assistant education was conducted on unnecessary antibiotics for viral illnesses and ways to overcome barriers. Patient engagement and education packets were placed in each clinic for providers to give to patients when appropriate.

RESULTS: Statistical testing determined whether differences occurred between visits per provider and percentages of antibiotic prescriptions written. Statistical significance was found as antibiotic prescriptions increased. Although more antibiotic prescriptions were written, sick visits and bacterial upper respiratory infections increased. Clinical significance demonstrated that clinics using two or more packets decreased overall antibiotic prescriptions written. Overall, clinics prescribed antibiotics for viral illnesses less than thirty percent of the time. Survey results indicated that most providers pledged commitment to antibiotic stewardship.

CONCLUSIONS: Patient engagement packets decreased antibiotic prescriptions written per clinic, and providers evaluated are committed to antibiotic stewardship. Antibiotic stewardship is critical to preventing future death from antibiotic-resistant infections. Antibiotic stewardship education and further data evaluation should continue.