Semester

Summer

Date of Graduation

2026

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Committee Chair

Melanie Whelan

Committee Member

Barbara Sherman

Committee Member

Afsoun Sichani

Abstract

Introduction: Urinary tract infections (UTIs) are one of the most common infections that require antibiotic therapy. Providers working in three urgent care clinics located in Eastern West Virginia diagnosis and treat UTIs based on their clinical judgement. Variability in clinical judgement results in inappropriate antibiotic use which has implications on antibiotic resistance and the financial burden of the patients as well as the entire organization.

Evidence Review: A total of 10 articles were evaluated to support the implementation of antibiotic stewardship initiatives that provide guidance in caring for this population. Interventions include electronic health record enhancements, provider education, and tracking antibiotic prescriptions and providing feedback to providers.

Purpose: The project aimed to increase preferred antibiotic therapy based on evidence-based guidelines and to reduce the amount of third-generation cephalosporins being prescribed to treat uncomplicated UTIs.

Methods: This project was implemented utilizing Kurt Lewin’s Change Theory. The primary intervention was the implementation of evidence-based antibiotic stewardship practices at three urgent care clinics. The effectiveness of the intervention was measured through outcome, process, and balancing measures and analyzed utilizing descriptive statistics.

Results: Following the intervention, there was a reduction in third-generation cephalosporin (cefdinir) prescribing from 24.4% pre-intervention to 2.2% post-intervention and overall, 89.5% of patients received a preferred antibiotic.

Conclusion: Patients were more likely to receive a preferred antibiotic during the intervention period. Return visits were infrequent and were most often attributed to diagnostic uncertainty or alternative diagnosis rather than true UTI treatment failure. Only 9 of 581 encounters (1.55%) were identified as possible treatment failures.  These findings suggest improved antibiotic stewardship without an increase in adverse clinical outcomes

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