Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Nurse Driven Clinical Decision Support

Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Implementation of Nurse Driven Clinical Decision Support

This study evaluates the effects of a novel integrated clinical prediction tool on antibiotic prescription patterns of nurses for acute respiratory infections (ARIs). The intervention is an EHR-integrated risk calculator and order set to help guide appropriate, evidence-based antibiotic prescriptions for patients presenting with ARI symptoms.

The proposed project will fill a critical gap in the evidence base and answer the important question: can pivoting ARI CDS tools towards nurses overcome established implementation barriers to reducing antibiotic use? The proposal is highly innovative in three ways: It uses CDS tools to embed evidence-based risk stratification to enable nurse-led ARI management. It creates a nurse training program to support this nurse-led ARI treatment pathway. It will be evaluated and optimized using evidence-based implementation frameworks that will guide assessment of the fidelity, acceptability, adoption, cost, and sustainability of the tool. This will provide comprehensive implementation measures, formative and summative, and enable a rigorous understanding of barriers and facilitators to implementing nurse-led CDS tools for reducing antibiotic overprescribing. This study will provide much needed guidance on how to implement CDS-enabled, nurse-led ARI assessment and treatment to reduce antibiotic overprescribing.

Inclusion Criteria:

Clinics:

• must be primary care and/or urgent care clinics
• should have a minimum of one registered nurse (RN) full time equivalents (FTE)

Nurses :

• be licensed to see patients and prescribed and/or recommend prescriptions for patients
• work a minimum of 0.5 FTE to ensure that they are seeing sufficient numbers of patients to maintain competency
• have access to the clinic EHR system, and use regularly as part of patient care

Patients:

• patients must have been seen at a participating clinic with a complaint of cough or sore throat.
• Ages 3-70 will be included for sore throat and ages 18-70 for cough

Exclusion Criteria:

• are unable or unwilling to provide informed consent
• are unable to participate meaningfully in an intervention that involves self-monitoring using software available in English (e.g., due to uncorrected sight impairment, illiterate, non-English-speaking, dementia)
• clinics will be excluded if phone call triage of patients with sore throat and cough is not performed by RNs
• Nurses will be excluded if they do not work with the clinic EHR as part of their workflow
• Patients with a history of chronic lung disease or immunosuppression will be excluded since the CPRs were not validated in these groups