Antibiotic stewardship: Improving patient-centered right care in urgent care using a shared decision aid and 5 Ds tool.

BACKGROUND: Overuse of antibiotics leads to antibiotic resistance, costing $35 billion and causing approximately 23,000 deaths in the United States annually. Antibiotic stewardship is important in urgent care centers to prevent antibiotic resistance.

LOCAL PROBLEM: Providers prescribed antibiotics to 80% of patients with viral conditions at this urgent care center. The aim of this quality improvement (QI) project was to improve right care for patients of 65 years and younger with upper respiratory infections and/or head, ears, nose, or throat viral illnesses presenting to urgent care from 36.2% to 80% within 90 days.

METHODS: Four rapid Plan-Do-Study-Act cycles were performed every two weeks. Four concurrent focus areas were used for team and patient engagement, antibiotic prescribing, and tracking right care.

INTERVENTIONS: There were four core interventions. These included biweekly team meetings, a shared decision aid (SDA), an antibiotic prescribing 5 Ds tool, and a case management log.

RESULTS: Use of the SDA improved patient engagement from 33% to 93%. The 5 Ds tool improved proper prescribing from 20% to 95%. Pediatric acute otitis media had the greatest improvement, with the proper diagnosis and the use of watchful waiting, delaying the filling of an antibiotic prescription.

CONCLUSION: Antibiotic stewardship and standardization of prescribing were improved in urgent care with the use of the 5 Ds tool. This QI project can be replicated for use in urgent care centers for compliance with the Joint Commission standards required.