Date of Award

Spring 5-3-2019

Document Type

DNP Project

Project Team Faculty Member

Dr. Mary Barron

Project Team Faculty Member

Dr. Kim White


Acute Bronchitis, Cough, Upper Respiratory Infections


There has been a significant rise in inappropriate antibiotic prescribing in the United States with at least 30 percent of antibiotics prescribed deemed unnecessary (Fiore, Fettic, Wright, & Ferrara, 2017). Overprescribing antibiotics for viral illnesses such as acute bronchitis leads to antimicrobial resistance. Based on current treatment guidelines, most upper respiratory infections do not respond to antibiotics but rather require supportive measures. Antibiotic prescribing trends for a Midwestern rural clinic were obtained through a retrospective and prospective chart review. Patients were frequently receiving antibiotics for acute bronchitis. To approach the problem a quality improvement (QI) evidence-based project was proposed. A decision flowsheet for the diagnosis and treatment of acute bronchitis was implemented from 11/1/2018-2/28/2019. Unfortunately, the decisional flowsheet was not used to the full extent and negatively impacted project outcomes. Statistical analysis could not performed as providers admitted to using “acute sinusitis” in order to prescribe antibiotics when the diagnosis may have been acute bronchitis. Barriers to change were identified, including attitude of providers, pressure of productivity, high volume of patients, and lack of investment in students. Changing antibiotic prescribing practices for acute bronchitis and other diagnoses remains a high priority for federal, state, and local health care (AHRQ, 2019). Discussion among prescribers, identification of champions for QI, university affiliation in QI, and public expectations of antibiotic prescriptions are future priorities as lessons learned.

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Background DNP.docx (112 kB)

Problem Statement DNP.docx (56 kB)
Problem Statement

Clinical Relevance-DNP.docx (94 kB)
Clinical Relevance

Lit review- DNP.docx (120 kB)
Literature Review

Conceptual Framework-DNP.docx (108 kB)
Conceptual Framework

Methodology Acute Bronchitis-2 final.docx (18 kB)

DNP Evaluation-2 final.docx (14 kB)
Evaluation Process

References-2 final.docx (18 kB)
Reference List

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