Improving Adherence to Clinical Practice Guidelines for the Treatment of Acute Otitis Media in Pediatric Patients

Abstract

Abstract

Background: The management of acute otitis media (AOM) in pediatric patients has been a growing issue throughout healthcare. AOM is the second most common pediatric diagnosis seen in outpatient clinics. It is noted that approximately 80% of children will have a diagnosis of AOM at least once in their lifetime. AOM leads to an increase in healthcare cost in the United States. The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology (AAO) all note that the management of AOM is a significant problem throughout the United States. The AAP notes that children under the age of 2 years should be treated with antibiotics for AOM, while children 2 years of age and older should refrain from antibiotic use for 48 to 72 hours pending assessment and symptoms. The main clinical problem addressed throughout this project is clinic providers not following clinical practice guidelines as they were unaware of them which is leading to inappropriate management of AOM. Objectives: The main objective of this quality improvement project was to provide clinicians with an up-to-date evidenced-based algorithm and education on diagnosis, treatment, and management for AOM for children between the age of two and eighteen years. The population was all providers in an urgent care and emergency department in rural Iowa. Methods: The previous algorithm was updated and modified according to the recommendations of the American Academy of Pediatrics. Providers were educated via an emailed PowerPoint on the significant of the clinical problem AOM and the newly updated algorithm and modifications, significance of the clinical problem of AOM and the newly updated algorithm which included the specific modifications that were made, the watch and wait component, and current recommendations. Caregivers/Parents were also educated on the recommendations with flyers in the exam rooms along with handouts at discharge. Electronic medical records (EMR) were used to collect the percentage of providers utilizing the current clinical practice algorithm pre and post-intervention. Other data collected included number and type of antibiotic prescriptions. Results: Upon completion of the project, there was a 35% increase in adherence to the clinical practice guideline algorithm. There was also an 18% decrease in antibiotics prescriptions overall and a 12% increase in the use of first-line antibiotic therapy with Amoxicillin. Conclusion: The importance of proper management of AOM by following evidenced-based clinical practice guidelines is recommended in clinical settings but even more imperative when considering the impact of antibiotic use and stewardship. There was a 35% increase in adherence to the clinical practice guideline algorithm from pre-intervention to post-intervention. Education in multiple forms and multiple occasions played a key role in the success of this project. Sustainability will be achieved through continuous education and proposal to other clinics throughout Greater Regional Health and other clinical practice algorithms will be evaluated and updated as needed.