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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2023

Open Access 01-12-2023 | Antibiotic | Study Protocol

Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial

Authors: Elizabeth R. Stevens, Ruth Agbakoba, Devin M. Mann, Rachel Hess, Safiya I. Richardson, Thomas McGinn, Paul D. Smith, Wendy Halm, Marlon P. Mundt, Katherine L. Dauber-Decker, Simon A. Jones, Dawn M. Feldthouse, Eun Ji Kim, David A. Feldstein

Published in: BMC Medical Informatics and Decision Making | Issue 1/2023

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Abstract

Background

Overprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.

Methods

Following qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout.

Discussion

This study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings.

Trial registration

ClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, https://​clinicaltrials.​gov/​ct2/​show/​NCT04255303.
Appendix
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Metadata
Title
Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial
Authors
Elizabeth R. Stevens
Ruth Agbakoba
Devin M. Mann
Rachel Hess
Safiya I. Richardson
Thomas McGinn
Paul D. Smith
Wendy Halm
Marlon P. Mundt
Katherine L. Dauber-Decker
Simon A. Jones
Dawn M. Feldthouse
Eun Ji Kim
David A. Feldstein
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2023
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-023-02368-0

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