Antibiotic Stewardship: Implementation of the Centor Tool
Presentation
Overview
Overview
Description
Purpose:Decrease unnecessary testing and inappropriate antibiotic when evaluating patients with complaints of pharyngitis. Background: Antibiotics are prescribed daily with rates being highest in outpatient settings. (Stenehjem et al., 2020). Clinicians must have training and guidelines in place to curtail the inappropriate prescribing of antibiotics. More than two million antibiotic resistant infections in the United States (U.S.) have been reported because of overprescribing (Sanchez et al., 2016). Greater than 12 million office visits annually are due to symptoms of pharyngitis (Arnold and Nizet, 2018). Although approximately 50 to 80% cases of pharyngitis are viral in nature, it remains one of the most common illnesses for which antibiotics are prescribed with more than 60% of those cases receiving a prescription (Wolford et al, 2022). The incorrect treatment of pharyngitis has detrimental effect on patients across the globe. The World Health Organization (2022, para 1) uses the following slogan to highlight the importance of this issue: “Antimicrobials: Handle with Care”, highlighting that antimicrobial medicines, such as antibiotics, are a precious resource and should be used prudently.” Methods: A data collection tool was utilized for chart reviews during a 12-week period. Data from each chart reviewed indicated Centor tool data recorded, whether a strep test and/or culture was completed, the result of the test, and if an antibiotic was prescribed. Data was tracked weekly and compared to pre-implementation data to analyze trends in improvement during the progression of the twelve-week period to determine if the number of Centor scores documented increased and if tests ordered were based on the Centor tool recommendations. Results: During the 12-week implementation period of the 212 patient encounters,69% (n=148) had Centor criteria documented. Centor scores varied from -1 to 4 with a total of 169 strep tests ordered. Overall Centor documentation improved and antibiotic prescribing rates decreased. Overall rates for compliance varied weekly from 38% to 89%. Of the 212 encounters 32 prescriptions were written with 54% (n=17) a direct result of a positive strep test, positive throat culture, or met Centor guidelines for empiric therapy. Conclusion: Using this tool to determine test need, rather than testing based on patient request or reassurance, helped to decrease unnecessary testing which results in improved healthcare outcomes and aligned with the research and national organization recommendations that the Centor tool is effective and useful in aiding clinical decision making while improving patient outcomes.Clinical calculating tools add an additional element to our decision-making and can further support the providers recommendation. It can be used a visual aid when discussing with patients their likelihood of having a viral vs bacterial pharyngitis. Using the Centor tool as part of the screening process for sore throat complaints aims to improve the standards of care to ensure patients are screened in the same manner and will help to follow similar documentation within charts. The recent pandemic changed how healthcare can be efficiently and effectively delivered given the significant increase in virtual visits. This tool has proven to be effective when assessing and treating patients virtually and can easily be implemented in future practice.
