A model for improving and assessing outpatient antibiotic stewardship interventions for common upper respiratory tract infections and UTI, to improve appropriate outpatient antibiotic prescribing in order to improve patient safety, patient cost, and reduce antimicrobial resistance in accordance with the Joint Commission goal of reducing outpatient antibiotic prescriptions for 2020.

Authors

Jennifer Garcia
Jasmina Demirovic
Melinda Montoya
Niraj Ganjawala
Michael Palestine
Abhishek Tomar, Christus St. Vincent Hospital
William Bowen, Christus St. Vincent Family Medicine Residency

Document Type

Poster

Publication Date

3-6-2020

Abstract

Aim statement:

Reduce inappropriate antibiotic use by 20% for upper respiratory tract infection (bronchitis, sinusitis, pharyngitis) and UTI from December 2018-March 2019 compared to December 2019-March 2020.

Methods:

A single center before and after intervention study using a quasi-experimental design utilizing the electronic medical records system to identify patients diagnosed with URIs or UTI in six main ambulatory care settings.

• Inclusion criteria
  • Diagnosis of bronchitis, sinusitis, or UTI
  • Timeframe: December 1, 2018 through March 31, 2019

• Exclusion criteria
  • Requirement for antibiotics for other indication(s)
  • Immunocompromising conditions
  • Presence of COPD, cystic fibrosis or bronchiectasis

• The following data points were analyzed
  • Total number of antibiotics prescribed
  • Number of inappropriate antibiotic prescriptions based on:
  • Antibiotic initiation
  • Antibiotic choice
  • Antibiotic duration

Return to clinic or ED within 72 hours

Findings:

• Over half of outpatient antibiotic prescription are inappropriate
• Initiation of antibiotics was inappropriate in 32% of the patients
• Most patients were treated with antibiotics for more than 5-7 days

Interventions that have been implemented as of December 1, 2019

• Clinical pathway for select disease states and order sets
• Prospective audit and feedback on target oral antibiotics
• Education (provider and patient)
• Audit and Feedback

Post interventional data: Around March 31, 2020

Comments

Presented at the University of New Mexico Health Science 2020 Annual Quality Improvement and Patient Safety Symposium

Recommended Citation

Garcia, Jennifer; Jasmina Demirovic; Melinda Montoya; Niraj Ganjawala; Michael Palestine; Abhishek Tomar; and William Bowen. "A model for improving and assessing outpatient antibiotic stewardship interventions for common upper respiratory tract infections and UTI, to improve appropriate outpatient antibiotic prescribing in order to improve patient safety, patient cost, and reduce antimicrobial resistance in accordance with the Joint Commission goal of reducing outpatient antibiotic prescriptions for 2020.." (2020). https://digitalrepository.unm.edu/hsc_qips/12