Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judith Daniels

Clinical Mentor

Dr. Julie Wolford

Committee Member

Dr. Julie Ossege

Abstract

Abstract

BACKGROUND: Nationally, approximately one third of antibiotics are currently being prescribed unnecessarily. Antibiotic misuse can result in disability, longer hospital stays, increased costs to organizations, antibiotic resistance and death.

PURPOSE: The purpose of this project was two-fold: (1) explore current management of acute adult rhinosinusitis in an outpatient setting (2) assessing providers perceptions on the barriers to preventing antibiotic misuse.

METHODS: A retrospective chart review of 150 charts was performed to examine prescribing practices by providers treating rhinosinusitis at two primary care practices. An interview was conducted with the practice providers on barriers for compliance in antibiotic stewardship.

RESULTS: In the treatment of acute sinusitis within the two sites, antibiotic prescriptions were given for 88% of patients with less than seven days of symptoms, with 93% of patients receiving antibiotics overall in sinusitis treatment and 86% receiving supportive therapies. Reported symptoms and physical exam findings did not impact antibiotic prescription, with reported symptoms not confirmed in the exam. Provider interviews revealed barriers to avoiding prescribing antibiotics included lack of provider and patient education and patient satisfaction.

CONCLUSION: The over prescribing of antibiotics is complex, complicated by patient demand and satisfaction, patients not knowing the risk of antibiotics, and providers not being able to counter patient’s request for treatment. Providers identified the need for patient education, but this needs to be provided prior to the office visit. Practices must commit to appropriately prescribing antibiotics. Utilizing the data collected through this project help create education directed toward patients.

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