Abstract

Problem: Acute otitis media (AOM) is a leading cause of pediatric antibiotic prescribing in urgent care (UC) settings. Despite guidelines recommending watchful waiting, inappropriate prescribing persists, contributing to increased antimicrobial resistance and healthcare costs. This quality improvement project aimed to enhance antimicrobial stewardship through provider education and clinical decision-making support tools.

Intervention: Utilizing the Plan-Do-Study-Act framework, the 30-day intervention was implemented across Midwestern UC centers. The intervention involved asynchronous provider education focused on evidence-based prescribing, watchful waiting strategies, and caregiver communication.

Measures: Primary outcomes included provider confidence in implementing watchful waiting and perceived adherence to clinical guidelines, measured via pre- and post-intervention surveys. The secondary outcome was antibiotic prescribing rates, compared across a 60-day pre-implementation period and 30- day post-implementation, using retrospective electronic health record (EHR) review.

Results: Five providers completed both pre- and post-intervention assessments. Post-intervention changes in provider confidence and communication were not statistically significant, t(4) = 1.59, p = .186. Antibiotic prescribing rates demonstrated a slight decrease from 95.53% (n = 582) pre-intervention to 95.03% post-intervention (n = 262) post-intervention, suggesting a small but clinically meaningful improvement. Providers also reported high satisfaction with the intervention and perceived improved alignment with prescribing guidelines.

Conclusion: This quality improvement project suggests that provider education may enhance confidence and willingness to modify prescribing practices, but may not result in statistically significant behavioral changes in the short term. Educational interventions may be more effective when combined with additional strategies to support sustained improvements in prescribing behavior.

Description

NRS 890 Doctoral Scholarly Project IV

Author Details

Madison Haines, DNP(c), RN. NICU and OR nurse with 4 years of experience. Graduating July 2026 with a Doctorate in Nursing Practice, specializing in Family Nursing Practice.

Gina Crudden, DNP, APRN-CNS, is the faculty advisor for the project.

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

Pilot/Exploratory Study

Keywords:

Acute Otitis Media, Antimicrobial Stewardship, Urgent Care, Watchful Waiting, Antibiotic Prescribing, Pediatric Care

Advisor

Gina Crudden

Degree

DNP

Degree Grantor

Nebraska Methodist College

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2026-07-15

Full Text of Presentation

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