Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Nurse Driven Clinical Decision Support

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

347 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-23

Study Completion Date

2025-12-15

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This study evaluates the effects of a novel integrated clinical prediction tool on antibiotic prescription patterns of nurses for acute respiratory infections (ARIs). The intervention is an EHR-integrated risk calculator and order set to help guide appropriate, evidence-based antibiotic prescriptions for patients presenting with ARI symptoms.

Related Clinical Trials

Explore similar clinical trials based on study characteristics and research focus.

Evaluation of an Algorithm to Reduce Antibiotic Prescribing for Acute Bronchitis

NCT00981994

Acute Respiratory Tract Infection

COMPLETED NA

Improving Antibiotic Use in Acute Care Treatment

NCT00144040

Respiratory Infections

COMPLETED NA

Patient Centered Communication Training to Reduce Antibiotic Use in Acute Respiratory Tract Infections

NCT00105248

Respiratory Tract Infections

COMPLETED NA

Evidence Based Decision Making: Integrating Clinical Prediction Rules

NCT01386047

Strep Pharyngitis Pneumonia

COMPLETED NA

Integrated Clinical Prediction Rules: Bringing Evidence to Diverse Primary Care Settings

NCT02534987

Strep Throat Pneumonia

COMPLETED NA

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

The proposed project will fill a critical gap in the evidence base and answer the important question: can pivoting ARI CDS tools towards nurses overcome established implementation barriers to reducing antibiotic use? The proposal is highly innovative in three ways: It uses CDS tools to embed evidence-based risk stratification to enable nurse-led ARI management. It creates a nurse training program to support this nurse-led ARI treatment pathway. It will be evaluated and optimized using evidence-based implementation frameworks that will guide assessment of the fidelity, acceptability, adoption, cost, and sustainability of the tool. This will provide comprehensive implementation measures, formative and summative, and enable a rigorous understanding of barriers and facilitators to implementing nurse-led CDS tools for reducing antibiotic overprescribing. This study will provide much needed guidance on how to implement CDS-enabled, nurse-led ARI assessment and treatment to reduce antibiotic overprescribing.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Acute Respiratory Infection

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

iCPR group

Clinic personnel (Providers and Nurses) will receive online training that includes: 1) an overview of the project; 2) iCPR workflows including triage; 3) CPR component review and risk categories; 4) history and physical examination components of the CPRs. The online training will be followed by in-person training to reinforce the online training and teach additional skills. In-person training sessions led by study team will last approximately 60 minutes, and consist of four basic components: 1) a review of the iCPR ARI protocol and tools; 2) on-screen walk-throughs of common scenarios employing the new tools; 3) physical examination technique practice with simulated patients; A 60-minute in-person follow-up nurse training will take place 4-6 weeks after implementation of the intervention.

Group Type EXPERIMENTAL

Integrated clinical prediction rule (iCPR) system (iCPR)

Intervention Type OTHER

The iCPR tool consists of an electronic calculator that can be used to determine whether the patient is at low, intermediate or high risk for having the diagnosis and a bundled order set (called a "Smartset"). The iCPR tool will be made available directly within the Electronic Health Record (EHR) for Registered Nurses (RNs) who are seeing patients fall into the study categories. The iCPR tool through the use of order sets will guide the RN in the patient's care. The order set for patients at low risk for these diseases will recommend supportive care including over the counter cold remedies and pain relievers. The order set for patients at intermediate or high risk of these disease will recommend diagnostic tests (rapid strep antigen or CXR) to help determine if they have the disease. Based on the results of the diagnostic tests new order sets will recommend antibiotics or supportive care

Control no intervention group

standard care will continue as usual.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Integrated clinical prediction rule (iCPR) system (iCPR)

The iCPR tool consists of an electronic calculator that can be used to determine whether the patient is at low, intermediate or high risk for having the diagnosis and a bundled order set (called a "Smartset"). The iCPR tool will be made available directly within the Electronic Health Record (EHR) for Registered Nurses (RNs) who are seeing patients fall into the study categories. The iCPR tool through the use of order sets will guide the RN in the patient's care. The order set for patients at low risk for these diseases will recommend supportive care including over the counter cold remedies and pain relievers. The order set for patients at intermediate or high risk of these disease will recommend diagnostic tests (rapid strep antigen or CXR) to help determine if they have the disease. Based on the results of the diagnostic tests new order sets will recommend antibiotics or supportive care

Intervention Type OTHER

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

Clinics:

* must be primary care and/or urgent care clinics
* should have a minimum of one registered nurse (RN) full time equivalents (FTE)

Nurses :

* be licensed to see patients and prescribed and/or recommend prescriptions for patients
* work a minimum of 0.5 FTE to ensure that they are seeing sufficient numbers of patients to maintain competency
* have access to the clinic EHR system, and use regularly as part of patient care

Patients:

* patients must have been seen at a participating clinic with a complaint of cough or sore throat.
* Ages 3-70 will be included for sore throat and ages 18-70 for cough

Exclusion Criteria

* are unable or unwilling to provide informed consent
* are unable to participate meaningfully in an intervention that involves self-monitoring using software available in English (e.g., due to uncorrected sight impairment, illiterate, non-English-speaking, dementia)
* clinics will be excluded if phone call triage of patients with sore throat and cough is not performed by RNs
* Nurses will be excluded if they do not work with the clinic EHR as part of their workflow
* Patients with a history of chronic lung disease or immunosuppression will be excluded since the CPRs were not validated in these groups

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No