Doctor of Nursing Practice (DNP) Projects

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Degree Program

Doctor of Nursing Practice

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Family Nurse Practioner

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Month Degree Awarded



Antibiotic Associated Diarrhea, Probiotics, Evidence Based Practice Protocol, Primary Care Practice


Jeungok Choi, RN, PhD

DNP Project Chair

Jeungok Choi, RN, PhD

DNP Project Member Name

Joan P. Roche, PhD, RN, GCNS-BC

DNP Project Outside Member Name

Michael A. Kilgannon, MD



Antibiotic associated diarrhea (AAD) is defined as the self limiting diarrhea that occurs during or following a course of antibiotics (Bartlett, 2002; Dendukuri, Costa, McGregor, & Brophy, 2005; Pimental & Choure, 2009; Sullivan & Nord, 2005; Vrabie & Aberra, 2009). Despite strong support for the use of probiotics in the outpatient setting for preventing AAD, there is lack of probiotic utilization by primary care providers in the outpatient setting. Current literature indicates that one of the barriers to probiotic use is medical doctors’ (MDs) and nurse practitioners’ (NPs) attitude and lack of knowledge regarding the use of probiotics in preventing antibiotic associated diarrhea. The purpose of this study was to evaluate the current attitude and knowledge of providers (MD, NP and physician assistant [PA]) in a primary care practice in central and eastern Connecticut. Current attitude towards of the use of probiotics to prevent AAD was positive (p=0.083). The level of providers knowledge increased by 17.53% (p=0.002). NPs showed a greater increase in knowledge in the post test than MDs (F(21)=59.345, p=0.005). The second purpose of the study was to introduce an evidence-based protocol, during an educational intervention, for use in the adult outpatient setting. The third purpose of the study was to evaluate providers’ use of probiotics as documented in the Electronic Medical Record after the introduction of an educational intervention. There was a 50% increase in the number of providers recommending probiotics when prescribing an antibiotic. The result of this study showed providers have a positive attitude toward the use of probiotics to prevent AAD. There was also an increase in the provider knowledge of probiotic use after an educational intervention and the introduction of an evidence-based protocol. There was also an increase in the number of providers who recorded their recommendation of a probiotic when prescribing an antibiotic. Educational programs can be successful in introducing any evidence-based protocol. Further research is needed to evaluate if this increase in the use of probiotics is sustained. Further research is also needed to evaluate the extent providers implement the evidence-based protocol within their practice.

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