Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media.

Creator(s)

Alicia Daggett, Children's Mercy HospitalFollow
Donna Wyly, Children's Mercy HospitalFollow
Tanis Stewart, Children's Mercy HospitalFollow
Patricia Phillips, Children's Mercy HospitalFollow
Cassandra Newell, Children's Mercy HospitalFollow
Brian R. Lee, Children's Mercy HospitalFollow
Alaina N. Burns, Children's Mercy Kansas CityFollow
Nikita Sharma, Children's Mercy HospitalFollow
Nirav Shastri, Children's Mercy HospitalFollow
Jonathan Rodean, Children's Mercy HospitalFollow
Rana El Feghaly, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

3-1-2022

Identifier

DOI: 10.1097/PEC.0000000000002525

Abstract

OBJECTIVES: Acute otitis media (AOM) is the most common reason for pediatric antibiotic prescriptions. The 2013 American Academy of Pediatrics' AOM guidelines recommend observation for nonsevere AOM. Our aim was to increase the percentage safety-net antibiotic prescription (SNAP) offered to patients 6 months of age or older diagnosed with AOM in 2 pediatric emergency departments (EDs) from a baseline of 0.5% to 15% in 20 months.

METHODS: This is a quality improvement study at a quaternary pediatric medical center with 2 locations, both with EDs. A random chart review revealed that 27.5% of patients diagnosed with AOM in the ED would qualify for a SNAP, but only 0.5% were offered it. Quality improvement interventions were designed to improve safety-net antibiotic prescribing. Both EDs conducted multiple interventions, including algorithm development, provider education, and electronic medical record aids. The primary outcome measure was the percentage of patients offered a SNAP for AOM.

RESULTS: A total of 8226 children 6 months of age or older were diagnosed with AOM in our 2 EDs during the 20-month intervention period. The percentage offered a SNAP increased at both EDs. One ED had a single shift in the mean to 7.9%, whereas the other had 2 shifts in the mean, an initial shift to 5.1% and a second to 7.3%. Providers consistently used the algorithm and electronic medical record aids.

CONCLUSIONS: Safety-net antibiotic prescriptions in conjunction with parent education was effective in reducing the use of immediate antibiotic prescriptions in children with AOM in 2 pediatric EDs. Offering a SNAP can reduce unnecessary use of antibiotics, which in turn may decrease antibiotic-related adverse events and antibiotic resistance.

Journal Title

Pediatric emergency care

Volume

38

Issue

3

First Page

1151

Last Page

1158

MeSH Keywords

Acute Disease; Anti-Bacterial Agents; Child; Emergency Service, Hospital; Humans; Infant; Otitis Media; Practice Patterns, Physicians'; Prescriptions

Keywords

Acute Disease; Anti-Bacterial Agents; Hospital Emergency Service; Otitis Media; Physicians' Practice Patterns; Prescriptions

Recommended Citation

Daggett A, Wyly DR, Stewart T, et al. Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media. Pediatr Emerg Care. 2022;38(3):e1151-e1158. doi:10.1097/PEC.0000000000002525