Antibiotic prescribing strategy for acute respiratory tract infections in the emergency department

Purpose of the project: Unnecessary prescribing of antibiotic to treat acute respiratory tract infections (RTI) is recognized as a key contributor to antibiotic resistance and to public health. The aim of this project was to reduce antibiotic prescribing for RTIs by training Emergency Department (ED) providers to use the clinical pathway and the ideas, concerns and expectations (ICE) method. Methodology: A group training session was delivered to all current ED providers (n=23) at a 451-bed, acute-care not-for profit hospital in Northern New Jersey. The education was reinforced by printed flowcharts posted in the provider workstations summarizing the use of clinical pathway and ICE in the management of RTI. Pre and post-intervention chart review was completed to assess the antibiotic prescribing rate for RTIs. A total of 90 patients’ charts were sampled, 42 in the pre-intervention and 48 in the post-intervention period. Chi-squared test was utilized to assess whether there was a statistically significant difference in frequencies of antibiotic prescribing. Results: There was a statistically significant decrease in antibiotic prescribing for RTIs from 30.95% to 12.50% (p = .03) following the intervention. Additionally, there was an observed reduction in the use of diagnostic assays, although this was not statistically significant. In the follow-up survey majority of providers 84% expressed strong positive opinion that the ICE method should be adopted as part of the standard protocol during the patient-provider consultation. Implications for practice: This finding highlights the importance of stricter guideline adherence as well as enhanced communication between the patient and the provider.DNPIncludes bibliographical reference