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. 2024 Jul 26:14:200122.
doi: 10.1016/j.jpedcp.2024.200122. eCollection 2024 Dec.

Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics

Jennifer McKinsey  1   2 , Brian R Lee  1   2 , Donna Wyly  3 , Holly Austin  1   2 , Dinah Dosdos  1   2 , Emily Murdock  3 , Aimy Patel  1   2 , Rana E El Feghaly  1   2 , Amanda Nedved  1   2
Affiliations

Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics

Jennifer McKinsey et al. J Pediatr Clin Pract. .

Abstract

Objective: To evaluate the effectiveness of multifaceted interventions in improving the use of safety net antibiotic prescriptions (SNAPs) for nonsevere acute otitis media (AOM).

Study design: We used quality improvement methodology to develop iterative Plan-Do-Study-Act cycles to increase the use of SNAP for nonsevere AOM in 3 pediatric urgent care centers from October 2021 to June 2023. Interventions included education, electronic health record changes, audits and feedback, and a time-limited financial incentive. We measured the percentage of eligible patients with AOM offered SNAP as our primary outcome. Our secondary outcome measured the percentage of SNAPs accepted. Our process measure evaluated the percent of SNAP eligibility documentation. Our balancing measure evaluated the percent of return visits for AOM within 14 days of initial diagnosis. We used control charts to evaluate special cause variation.

Results: We reviewed 29 316 encounters. SNAP eligibility rates ranged from 27.6% to 45.5% over time. The percentage of eligible patients offered SNAP had 2 center line shifts, increasing from 7.2% to 49.7% as the rate of SNAP eligibility documentation had similar center line shifts increasing from 5.7% to 52.7%. There was no change in the rate of return visits for AOM of 4.3%. The number of SNAPs accepted each month had a center line shift increasing from a mean of 20 to 139.

Conclusions: The offering of SNAPs to patients with nonsevere AOM increased as clinician documentation of SNAP eligibility increased. This strategy could be implemented broadly to improve antibiotic stewardship.

Keywords: antibiotic stewardship; evidence-based practice; quality improvement.

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Conflict of interest statement

A.N. received grant support from Pfizer to study antibiotic stewardship with the 10.13039/100005295American Academy of Pediatrics. A.N. and R.E.E.F. receive grant support from Merck to study differences in antibiotic prescribing. The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Ishikawa diagram identifying barriers to offering SNAPs in the UC setting. AAP, American Academy of Pediatrics; tympanic membrane (TM).
Figure 2
Figure 2
Key driver diagram.
Figure 3
Figure 3
Documentation templates created for this project.
Figure 4
Figure 4
Standardized verbiage for telehealth guidance for patients with nonsevere otalgia.
Figure 5
Figure 5
P chart of the percent of eligible patients with AOM offered SNAPs with interventions annotated. AAP, American Academy of Pediatrics; CL, center line; LCL, lower control limit; PCP, primary care physicians; UCL, upper control limit.
Figure 6
Figure 6
A, P chart of the percent of SNAPs offered that families accepted. B, C chart of the number of SNAPs accepted. CL, center line; LCL, lower control limit; PCP, primary care physicians; UCL, upper control limit.
Figure 7
Figure 7
P chart of the percentage of encounters with a diagnosis of AOM with SNAP eligibility documented. CL, center line; LCL, lower control limit; PCP, primary care physicians; UCL, upper control limit.
Figure 8
Figure 8
A, P chart of the percent of patients who met criteria for receiving a SNAP. B, P chart of the percentage of encounters with AOM that had a return visit for AOM-related complaint within 14 days of the index visit. CL, center line; LCL, lower control limit; PCP, primary care physicians; UCL, upper control limit.
See this image and copyright information in PMC

References

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