Inappropriate antibiotic prescribing for urinary tract infections is a significant contributor to antimicrobial resistance, adverse drug events, and increased healthcare costs. It is estimated that at least 30% of outpatient antibiotic prescriptions are unnecessary, according to the CDC, and factors contributing to these unnecessary prescriptions in urgent care settings include limited time, workflow demands, and inconsistent access to guidelines.
To address this problem, 2026 DNP program graduate Mary Lou Palmer aimed to improve adherence to evidence-based UTI prescribing guidelines through the implementation of a quick-reference antibiotic guideline tool combined with targeted provider education in an urgent care clinic. Palmer conducted her research project at IU Health Broad Ripple Urgent Care.
Methods
A quasi-experimental pre–post design was used. The intervention included development and implementation of a quick-reference antibiotic guideline tool, created in collaboration with pharmacists, and a 15-minute provider education session delivered using a pre- and post-test format.
Primary outcomes included adherence to guideline-concordant antibiotic prescribing based on chart audits of adult UTI encounters. Secondary measures included provider knowledge assessed through pre- and post-education assessments and provider perceptions measured using a post-intervention Likert-scale feedback survey.
Retrospective chart audits were conducted for 6 months prior to the intervention, followed by prospective data collection for 3 months post-implementation. The quick-reference tool was strategically placed at points of care and within provider workflow areas, and clinicians completed a brief educational session. Post-intervention feedback surveys were distributed to assess usability and satisfaction.
Results
Guideline-adherent prescribing increased from 32% pre-intervention to 75% post-intervention. Inappropriate prescribing decreased, primarily due to improvements in antibiotic selection and duration. The average duration of first-line therapy, Macrobid, decreased from 7.3 to 5.6 days. Provider knowledge improved from 80% to 100%, and feedback indicated increased confidence in prescribing decisions.
Conclusion
Implementation of a quick-reference tool combined with targeted provider education significantly improved adherence to evidence-based UTI prescribing practices in urgent care. This low-cost, scalable intervention supports antimicrobial stewardship efforts and enhances patient safety through improved prescribing behaviors.
We spoke with Palmer to learn more about why she chose the DNP program and what inspired her project.
What inspired you to pursue a DNP?
I was inspired to pursue a DNP to expand my ability to lead change in clinical practice and improve patient outcomes through evidence-based care. As a nurse practitioner, I recognized the opportunity to influence systems of care and address practice gaps that impact patient safety and quality.
How did you become interested in this topic?
My interest in antibiotic stewardship developed through my clinical experience in urgent care, where I observed variability in prescribing practices and the challenges providers face in accessing guidelines at the point of care. This motivated me to focus on practical solutions that support evidence-based decision-making.
Who were your faculty or site mentors and what advice/words of wisdom did they offer that you'll most remember?
My faculty advisors, Dr. Terry Doescher and Dr. Debra Sipes-Fears, along with my site mentor, Amber Messick, and the IU Health pharmacy team, provided invaluable guidance and support throughout this project. One key takeaway I will carry forward is the importance of designing interventions that are simple, accessible, and aligned with clinical workflow to promote successful adoption and long-term sustainability.
Hopes for future impact on the nursing profession?
I plan to continue working PRN as a nurse practitioner in the urgent care setting while pursuing a full-time nursing faculty position to expand my role in education, leadership, and advancing APRN practice.
