Date of Graduation
Doctor of Nursing Practice (DNP)
School of Nursing and Health Professions
Dr. Alexa Curtis
Dr. Nancy Selix
Inappropriate antibiotic prescribing increases the prevalence of antibiotic resistance. While evidence-based practice guidelines can reduce antibiotic use, inconsistent adherence to these guidelines results in ineffective treatment, increased cost, and increasing antibiotic resistance.
At Athena Med-Monterey, a multi-provider primary care clinic where approximately 90% of the patients are women, written guidelines for uncomplicated urinary tract infections (uUTIs) in premenopausal non-pregnant women (PrMNPW) are lacking. In addition, there are no processes for assessing adherence to clinical guidelines.
The advanced practice nurse (APN) led a quality improvement process to assess and promote adherence to practice guidelines using a small test of change and the plan-do-study-act (PDSA) method. Qualitative assessment and retrospective chart review were performed to measure outcomes.
This project examined the clinicians’ adherence to evidenced-based guidelines and use of first-line agents to treat uUTIs in PrMNPW, and evaluated opportunities for ongoing practice improvement in treating uUTIs and adherence to clinical practice guidelines.
The quality improvement process successfully evaluated and promoted adherence to evidence-based practice guidelines. Both the qualitative assessment and retrospective chart reviews found that the clinicians used evidence-based guidelines and first-line agents to treat uUTIs in PrMNPW. No practice improvement intervention was needed for antibiotic treatment of this specific condition.
The clinicians’ adherence to the guidelines yielded desired practice and patient outcomes. The APN-driven small test of change and PDSA method demonstrated success in implementing a process to evaluate and promote evidence-based guidelines and first-line agents to treat infections in primary care.
Amayun, Ira, "Promoting Antibiotic Stewardship in Primary Care Setting: An Evaluation Process of Treatment Practices for Uncomplicated Urinary Tract Infections in Premenopausal Non-Pregnant Women" (2021). Doctor of Nursing Practice (DNP) Projects. 258.