Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2022


Doctor of Nursing Practice (DNP)

Primary Advisor

Cara Padovano, DNP, APRN; Victoria Nalls, PhD, GNP-BC, CWS, ACHPN


asymptomatic bacteriuria (ASB); antibiotics


Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) in older adults is challenging due to their atypical presentation. There is a critical gap in practice to adhere to clinical guidelines advising against treating ASB with antibiotics.

Objectives: The purpose of this Quality Improvement project was to implement an antibiotic stewardship program at a hospice organization to standardize judicious use of antibiotics at the end-of-life. The outcome measures were designed to evaluate clinician knowledge, prescribing policies and practice changes, the completeness of documentation, the appropriate usage of antibiotics, and clinician antibiotic use attitudes and beliefs.

Methods: Hospice clinicians were recruited using convenience sampling. A pre-post same subject and mixed-methods design was implemented for data collection and analysis. The key data collection tools were the Agency for Healthcare Research and Quality’s Suspected UTI SBAR form, the Antibiotic Use Attitudes and Beliefs Nursing and Provider Survey, and the Centers for Disease Control and Prevention’s Checklist for Core Elements of Antibiotic Stewardship in Nursing Homes. The outcomes were designed to be measured using paired t-test, chi-square tests, mean rating, descriptive statistics, and by identifying emerging themes.

Results: The baseline chart review revealed 136 prescriptions lacked the provider’s indication. There was no post-intervention data to compare and perform the chi-square tests due to a lack of study participation. Six people completed the knowledge surveys. The post-test mean score (66.67 [SD = 12.91]) was not significantly higher (p = 0.61) than the pre-test mean score (70.83 [SD = 18.82]). Two UTI SBAR forms were submitted with a 100% completeness rate. A freeze on new policy approvals prevented the project recommendations from undergoing the review process.

Conclusions: There was insufficient data to report whether the project improved the projected outcomes. The lack of study participation was attributed to the competing demands and burnout amidst the COVID-19 pandemic.

Open Access


Included in

Nursing Commons



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