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Improving Adherence to AAP Acute Otitis Media Guidelines in an Academic Pediatrics Practice through a Quality
Ryan M Wolf1, Kyle T Langford1,2, Barron L Patterson1
1Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn.
Insights
Adherence to pediatric acute otitis media (AOM) guidelines improved significantly after implementing a new note template and provider education. This quality improvement initiative enhanced antibiotic stewardship in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Quality Improvement
Background:
- Acute otitis media (AOM) is a leading cause of antibiotic prescriptions in children.
- Current guidelines from the American Academy of Pediatrics (AAP) aim to optimize AOM management and antibiotic use.
- Adherence to these guidelines, including the use of safety-net antibiotic prescriptions (SNAPs), was suboptimal in many clinical settings.
Purpose of the Study:
- To improve adherence to AAP AOM guidelines in an academic general pediatrics clinic.
- To increase the percentage of AOM encounters meeting guideline criteria from 78% to 90%.
- To enhance the appropriate use of SNAPs for eligible pediatric patients.
Main Methods:
- A quality improvement project was implemented in a general pediatrics practice.
- Interventions included a guideline-based ear pain note template, provider education, and workstation reminders.
- Data from 1266 AOM encounters were analyzed using P-charts to assess adherence.
Main Results:
- Adherence to AAP AOM guidelines increased from 78% to 92%.
- The use of the ear pain note template rose from 0% to 44%.
- The rate of eligible patients receiving a SNAP increased from 21% to 78%.
Conclusions:
- The implementation of a clinical decision support note template and educational sessions significantly improved adherence to AOM guidelines.
- This quality improvement initiative successfully enhanced the appropriate use of SNAPs, contributing to better antibiotic stewardship.
- The findings demonstrate the effectiveness of targeted interventions in optimizing pediatric AOM management.
Introduction:
Acute otitis media (AOM) is the most common reason for antibiotic use in children. The American Academy of Pediatrics (AAP) published its latest AOM guidelines in 2013. A safety-net antibiotic prescription (SNAP) is recommended for some patients based on age, severity, and duration of symptoms. At baseline, 78% of patients diagnosed with AOM in our general pediatrics practice met AAP guidelines, and 20% of eligible patients received a SNAP according to guidelines. We aimed to increase adherence to AAP AOM guidelines in an academic general pediatrics clinic from 78% to 90% by January 2020.
Methods:
A quality improvement team determined key drivers and developed interventions. Patients included were 6 months to 12 years old with AOM. Encounters were reviewed for adherence to AAP AOM guidelines. During the project, interventions included an ear pain note template, which generated guideline-based recommendations, note template education in clinic orientation sessions, a didactic session on AOM management, and reminders on workstations. Data were analyzed using P-charts.
Results:
Percent of AOM encounters (n = 1266) adhering to AAP AOM guidelines increased from 78% to 92%. We also reviewed two process measures. First, the use of the ear pain note template increased from 0% to 44%. Second, the percent of AOM encounters where an eligible patient received a SNAP increased from 21% to 78% (encounters n = 421).
Conclusion:
We demonstrate increased adherence to AAP AOM guidelines, including improved use of SNAPs after introducing a note template with clinical decision support and provider educational sessions.
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