Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Pedro Colio, PhD, DNP, RN, FNP-C, ENP-C, CCRN

Abstract

Purpose: This evidence-based practice (EBP) project aims to pilot a nurse practitioner-driven education utilizing the American Family Physician guideline (AFP) “IDSA Updates Guideline for Managing Group A Streptococcal Pharyngitis.” Acute pharyngitis is a frequently observed condition in outpatient clinics, but its optimal management continues to be of concern due to the overuse of antibiotics and corticosteroid treatments. The AFP Guidelines for acute pharyngitis include using the Centor criteria to guide the plan of care and the evidence-based antibiotic therapy for patients who score >4 on the Centor criteria or test positive for the rapid point of care testing.

Background: In the United States, urgent care and emergency room encounters are increasing and have high rates of inappropriate antibiotic prescribing for acute pharyngitis. This is also due to the rapid change in healthcare delivery and increased outpatient encounters in nontraditional healthcare settings, including urgent care. However, this rapid and convenient care has led to inappropriate antibiotic use, including 34% of patients prescribed an antibiotic among 1.16 million urgent care encounters. The gold standard in urgent care clinics should be to optimize treatment and minimize the risks of antibiotic resistance and adverse events by using the guideline.

Methods: The evidence-based practice framework guiding this practice change is Larrabee’s Model for evidence-based practice change. Research articles were compiled between September 2020 to January 2022. The nurse practitioners will be provided the AFP guideline, the Centor criteria, and antibiotic recommendations for each patient who presents with a sore throat in October 2021. Pre-data was collected between July and September 2020, and Post data was collected between November 2021 and February 2022.

Results: The data did not show statistical significance between the pre-and post-data. The providers did not follow the guidelines thoroughly, and therefore, they treated acute pharyngitis less likely in the post-data collection. Additionally, many patients were seen for COVID-19 with a “sore throat” complaint and were routinely tested for COVID-19. The sore throat was determined as a symptom of COVID-19 vs. being tested for acute pharyngitis. The adherence of the providers to follow IDSA guidelines was often tricky during the spike of COVID-19 regarding antibiotics. Regarding corticosteroids, the providers were able to abstain from using in response to a patient complaint of sore throat nearly 100%.

Evaluation: The COVID-19 pandemic exhibited a challenge with following evidence-based guidelines for acute pharyngitis. The outcome of this evidence-based project was not significant; however, additional data would be significant to obtain as the overall patients with COVID-19 decrease to determine if the education was genuinely significant in practice. Therefore, additional study is needed to determine how the outcomes of COVID-19 affected the ability of providers to follow evidence-based guidelines, and additional data should be collected for two more months.

Implications for Clinical Practice: This project aims to improve the overuse of antibiotics and corticosteroid use for treatment. This evidence-based project will take three months to complete, and all data will be cleansed of patient identifiers.

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