QI Project Promoting NP Compliance with an AOM Bundle in Pediatric Hospital-owned Retail Clinic

The most common diagnosis for pediatric antibiotic prescriptions is acute otitis media (AOM). Therefore, it is logical to focus on AOM when striving to improve antibiotic prescribing in pediatrics. This quality improvement project aimed to improve documentation of diagnostic criteria and physical examination findings in the medical record and improve adherence to recommended antibiotic prescribing recommendations for AOM by nurse practitioners at a children's hospital-owned pediatric retail clinic.

We used The Institute for Healthcare Improvement's Quality Improvement methodology to introduce an AOM quality bundle to providers in a pediatric retail clinic. We created Plan-Do-Study-Act ramps and implemented interventions, including NP education, electronic medical record improvements, and parent engagement. The percentage of compliant bundles (all five specific predetermined criteria successfully met) was measured for all patients diagnosed with AOM.

Baseline AOM bundle compliance began at a mean of 42%. Pareto analysis of baseline data indicated that antibiotic choice and duration were key failure modes. Antibiotic choice or duration errors occurred in 48% of reviewed charts at project inception. The interventions introduced throughout the project led to steady improvement in the percent of compliant bundles. The goal of 95% compliant bundles was achieved and maintained. At the project's conclusion, 98% of antibiotic prescriptions were accurate.

Implementation of multiple interventions with increasing levels of reliability improved the overall quality of documentation and increased the appropriate antibiotic prescriptions provided for patients diagnosed with AOM and seen by nurse practitioners at the retail clinic.