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Upper Respiratory Infections
Evidence-based practice guidelines
The PICOT question was tested using two Independent Samples t-test on the mean scores of the WURSS-11 on pre and post intervention groups divided on whether or not guidelines were used. In the pre-intervention group (n =100), there was not a significant difference in the WURSS scores for guidelines followed (n = 51, M = 15.29, SD = 16.35) and guidelines not followed (n = 49, M = 19.10, SD = 13.51) at t (98) = -1.253, p = 0.213. In the post-intervention group (n =100), there was not a significant difference in the WURSS scores for guidelines followed (n = 55, M = 25.35, SD = 15.67) and guidelines not followed (n = 45, M = 25.02, SD = 15.03) at t (98) = .105, p =0.917
Over 100 million antibiotic prescriptions are written each year, many for viral Upper Respiratory Infections. The antibiotic prescript may promote antibiotic resistance, cause side effects, and increase financial burden. Providers often lack evidence-based practice guidelines and feel pressured by patients to order antibiotics.
The results were statistically not significant, only with a slight increase in adherence to CDC treatment guidelines. A multi-faceted approach to educate providers as well as patients is necessary to reduce the use of antibiotics to improve patient outcome, avoid antibiotic resistance, avoid side effects and lessen the economic burden of URIs
Nursing and Healthcare Implications
Does the implementation of evidence-based guidelines, compared to not using guidelines in the urgent care setting improve patient outcome in adult patients with upper respiratory infections and pharyngitis?
The short term objective is to improve the application of evidence-based practice guidelines for URI in the urgent care setting.
Long term, evidence-based practice guidelines for URI should be implemented in any practice setting , should be easily accessible and user friendly. Nursing is in the ideal position to advance EBP and continue as patient advocates. More education is crucial for patients and providers. Patient education must be extended into communities and school to increase health literacy and to emphasize prevention.
Prior to implementation of EBP guidelines evaluate 100 urgent care patients with URI diagnosis using the Wisconsin Upper Respiratory Symptom Scale (WURSS). Next, provider meetings to share results and implement EBP, distribute patient education material. Post-implementation evaluate 100 urgent care URI patients using the same method.
Heike K. Huchler DNP, APRN, FNP-BC
CDC (2015). Get smart: Know when antibiotics work: Adult treatment recommendations. Retrieved from
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Fashner, J. Ericson, K. & Werner, S. (2012). Treatment of the common cold in children and adults. American Family Physician 86(2): 153-159.
Grijalva, C. G., Nuorti, J., P., & Griffin, M., R., (2009). Antibiotic Prescription rates for acute respiratory tract infections in US ambulatory settings. Journal of American Medical Association 302(7): 758-766..
Obasi, C. N., Brown, R., L., & Barrett, B. P., (2014). Item reduction of the Wisconsin Upper Respiratory Symptom Survey (WURSS-21) leads to the WURSS-11. Quality Life Res (23) 1293-1298. doi 10.1007/s11136-013-0561-z.