Improving Prescribing for Otitis Media in a Pediatric Emergency Unit: A Quality Improvement Initiative. Issue 1 (16th January 2023)

• Record Type: Journal Article
• Authors: Dube, Amanda R.; Zhao, Amy R.; Odozor, Chioma U.; Jordan, Katherine; Garuba, Favour O.; Kennedy, Angela; Niesen, Angela; Kyrouac, Rebecca C.; Stortz, Danielle; Lodhi, Hafsa; Newland, Jason G.; Adeyanju, Oloruntosin
• Is Part Of: Pediatric quality & safety. Volume 8:Issue 1(2023)
• Page Start: e625
• Publication Date: 2023-01-16
• Subjects: Pediatric nursing -- Periodicals; Pediatrics -- Periodicals; Patients -- Safety measures -- Periodicals; Children -- Hospital care -- Periodicals; 618.92
• DOI: 10.1097/pq9.0000000000000625
• Languages: English
• ISSNs: 2472-0054

Abstract

Abstract : Introduction: Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. The American Academy of Pediatrics (AAP) recommends shorter antibiotic courses and wait-and-see prescriptions (WSPs) for healthy children with mild-to-moderate AOM. Still, clinicians do not consistently prescribe these in pediatric emergency units (EUs). Methods: We performed a quality improvement project to improve antibiotic prescribing in a tertiary pediatric EU over 16 months, focusing on shorter prescription durations and WSPs. We assessed AOM management via chart review, then implemented interventions, including clinician education, a guideline card, visual reminders, and updated emails. In addition, we contacted a percentage of families after their visit to assess their child's outcome and parental satisfaction. Results: Our baseline data showed that only 39% of patients prescribed antibiotics were prescribed an appropriate duration based on age and estimated AOM severity, and only 3% were prescribed WSPs. Via 2 plan-do-study-act (PDSA) cycles, we increased the percentage of patients who received appropriate antibiotics to an average of 67%, sustained for >6 months. Follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. We did not see a substantial increase in WSPs. Conclusions: AOM management in our children's hospital's EU was often inconsistent with AAP guidelines. Two PDSA cycles improved the rate of appropriate duration antibiotics, and follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. The next steps involve developing an order set and implementing individualized feedback.