Antimicrobial Stewardship in an Outpatient Clinic

Purpose: The purpose of this project was to provide outpatient provider education related to current antimicrobial guidelines and resources available to them in order to combat antibiotic resistance in Yuma, Arizona. This project took place at YRMC Transitional Care Clinic, where the majority of the providers are nurse practitioners (NPs) or physician’s assistants (Pas). Background: It is well evidenced that antibiotic usage is a problem globally. Antibiotics typically are cheap and easy to prescribe which further enables their misuse and overprescribing. In the United States (U.S.), as nurse practitioners and physician assistants further fill the gaps as primary care providers, it is imperative that there are programs and educational services promoting the appropriate use of antibiotics to further decrease the likelihood of antimicrobial resistance. Methods: The project design was a quality improvement (QI) project to assess the effect of an educational in-service on provider ordering of antibiotics in the clinic. A pre-survey was administered via Qualtrics using the provider’s phone or laptop. The in-service was provided and lasted approximately 40 minutes. One session was held in-person at the clinic and the next day the second session was held virtually for providers who weren’t able to attend the in-person option. A post-survey was administered immediately after the training via Qualtrics. Results: The providers were engaged and interested in the information and the outcomes as described above attest to the intention for improvement by the providers who participated in this activity. Providers went into this activity with a generally confident approach when asked about prescribing antimicrobials. After they were provided the education and had a chance to interact with the antibiogram for patient scenarios, they were able to see a difference and reported that they would likely modify their prescribing practices. Conclusions: In conclusion, a targeted program for antimicrobial stewardship in the outpatient setting will likely improve antimicrobial usage and prescribing practices. Many providers did not know that a local antibiogram existed or where to access it. Providers could benefit by routine in-services that target particularly higher risk outcomes, such as antibiotic resistance