Program Schedule

Impact of an Educational Intervention to Improve Antibiotic Prescribing for Nurse Practitioners (NPs) in a Pediatric Urgent Care Centers (UCC)

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Up to 21% of ambulatory pediatric visits result in an antibiotic (abx) prescription and a large portion of these are unnecessary. NP’s play a critical role in patient care and are frequent prescribers of abx. It is estimated that 6.8 million yearly ambulatory visits are seen by NP’s. No data are available on NPs prescribing for common infections or on antimicrobial stewardship interventions to improve prescribing among NPs.

Objective: Determine if educational sessions would reduce inappropriate abx use among NPs in pediatric UCCs.

Methods: Intervention study evaluating NPs abx prescribing patterns at 4 pediatric UCCs following live educational sessions for urinary tract infection (UTI), skin and soft tissue infection (SSTI), pharyngitis, upper respiratory tract infection (URI), otitis media (OM) and sinusitis.  ICD9-CM codes were used to identify cases for 2 pre and 3 post intervention months in 2013. Abx appropriateness was based on published guidelines.

Results: A total of 26/43 (60%) NPs in 4 UCCs were enrolled in the study. Median years as an NP was 5 (IQR 3-12 yrs) with 2 years (IQR 1-5 yrs) in the UCC setting. The overall rate of inappropriate initial abx use was 10% pre intervention and 8% post intervention (p = 0.02). There was a decrease in inappropriate abx use in those who attended the educational session over those who did not (p <0.01). There was no difference in abx prescribing practice when looking at years as an NP (p 0.4) or years worked in an UCC (p 0.7)


Inappropriate Antibiotic Use

Pre                    Post                  P value

Most Common Reason Abx Deemed Inappropriate


Viral Pharyngitis

7/245 (2%)       15/301 (5%)      0.2

Not Indicated (100%)

GAS Pharyngitis

12/55 (22%)     10/107 (9%)     <0.001

Wrong Dose (50%)


36/38 (95%)     9/46 (19%)       <0.001

Too Narrow (40%)


3/34 (9%)         16/94 (17%)      0.25

Too Broad (53%)


90/397 (23%)    88/428 (21%)   0.46

Too Broad (61%)


3/9 (33%)          2/11 (18%)       0.44

Too Broad (40%)

Viral URI

21/913 (2%)      3/818 (0.3%)    0.001

Not Indicated (100%)

 Conclusion: Educational sessions led to improvement in overall inappropriate abx use specifically with UTI, viral URI and GABHS groups. Improvement did not occur in OM, SSTI, sinusitis and viral pharyngitis. Additional stewardship interventions are needed to further reduce unnecessary abx use.

Gina Weddle, DNP, RN, CPNP1, Angela Myers, MD, MPH2, Jason Newland, MD2, Jennifer Goldman, MD2, J. Christopher Day, MD3, Leslie Stach, PharmD, BCPS4 and Diana Yu, PharmD, BCPS2, (1)Infectious Disease, The Children's Mercy Hospital, Kc, MO, (2)Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, (3)Children's Mercy Hospital and Clinics, Kansas City, MO, (4)Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL


G. Weddle, None

A. Myers, None

J. Newland, Pfizer: Grant Investigator, Grant recipient

J. Goldman, None

J. C. Day, None

L. Stach, None

D. Yu, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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