Improving Prescribing for Otitis Media in a Pediatric Emergency Unit: A Quality Improvement Initiative

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 pediat...

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Bibliographic Details
Published in:Pediatric quality & safety 2023-01, Vol.8 (1), p.e625-e625
Main 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
Format: Article
Language:English
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Individual QI Projects From Single Institutions
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Summary: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). 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. 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. 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.
ISSN:2472-0054
2472-0054
DOI:10.1097/pq9.0000000000000625