Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Kimberly Woodruff, MD, MPH

Second Advisor

Joseph Burkard, DNSc, CRNA

Abstract

Background: Historically primary and secondary syphilis were seen primarily among men who have sex with men and rates among women remained low and rarely increased. Recent research shows that between 2013–2017, the primary and secondary syphilis rate increased 72.7% in the U.S. and 155.6% among women. Patients diagnosed with syphilis have a two to five fold increased risk of acquiring human immunodeficiency virus (HIV). Additionally, positive testing for other sexual transmitted infections (STI) might be indicators of high risk sexual behaviors and exposures that place a person at greater risk for acquiring syphilis and HIV. A southern California university student health center is treating and providing primary care to young adult college students, many of whom seek STI screening and testing. Clinic management has implemented screening tools within the electronic health record (EHR) and provider education on HIV and syphilis screening recommendations as an evidence-based practice intervention to improve provider compliance in recommending syphilis and HIV screening after positive STI testing to young adult college students.

Purpose: The aim of this evidence-based project is to increase recommendations for syphilis and HIV screening following positive STI testing in young adult college students through provider education and implementation of screening tools within the EHR.

Methodology: The Iowa Model guided this project. De-identified baseline data will be retrieved from the University of San Diego Student Health Center EHR system. Data points will include the number of positive STI tests for chlamydia, gonorrhea, syphilis, and HIV for the 2018-2019 academic year (September 2018-August 2019). Further data points will include the number of syphilis and HIV testing recommendations that followed positive STI testing. In October 2019, provider education was provided on recommendations for syphilis and HIV testing following positive STI testing. Outcome data will be obtained 3 months after provider education is completed. After 3 months, pre/post intervention data will be analyzed to evaluate effectiveness of provider education.

Evaluation Results: After provider education and implementation of EHR template, 97% of students were recommended HIV testing and 94% were recommended syphilis testing following positive STI results. Compliance with the EHR template was 29% leaving room for compliance improvement in EHR charting continuity among providers.

Implications for Clinical Practice: The implementation of screening tools within the EHR and provider education on syphilis and HIV screening recommendations will improve the early detection of syphilis and HIV and allow for prompt treatment to reduce long term health effects associated with syphilis and HIV. In addition, it will allow providers to educate patients on safe sexual health behaviors to prevent exposure to syphilis and HIV.

Conclusions: Initiating evidenced-based screening recommendations for syphilis and HIV after positive STI testing will help decrease complications and co-morbidities associated with exposure to syphilis and HIV in the young adult college student population.

Available for download on Thursday, April 29, 2021

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