Publication Date

Spring 2017

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Lori Rodriguez

Second Advisor

Vivian Wong

Third Advisor

Edwin Cabiago


Antibiotic stewardship, Antimicrobial stewardship, Nursing homes, Long-term care


This study was part of a quality improvement effort of a Skilled Nursing Facility (SNF) to develop and establish an antimicrobial stewardship program to comply with recently enacted California State Senate Bill 361 (SB 361), which went into effect January l, 2017 (Skilled nursing facilities, 2015). The division of the facility into two sections, one staffed largely by Licensed Vocational Nurses (L VNs) and another staffed largely by Registered Nurses (RNs) provided an study opportunity that easily differentiated the licensed nurses. This study used three methods: 1) an educational intervention to licensed nurses, 2) a post-educational intervention survey of licensed nurses, and 3), a retrospective medical chart audit of facility residents before and after the educational intervention. There was no significant difference demographic between L VNs and RNs. All agreed antimicrobial stewardship was important. While there was an increase in adherence to standardized infection criteria post-educational intervention, the most significant change was in the prescribing behavior by nurse practitioners (NPs ).

In conclusion, concentrating educational efforts on NPs and allowing them to practice in all areas of a SNF, may provide the greatest impact on the success of antimicrobial stewardship programs in these facilities.


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