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

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.

Over-the-Counter Medication Prescribing in a Pediatric Emergency Department: Health Records Review.

OBJECTIVE: The purpose of this project was to describe patterns in over-the-counter medication prescribing for nonacute patients with Medicaid in a pediatric emergency department. Differences were also tested in visit time and charges between patients with and without over-the-counter medication prescriptions. METHODS: Retrospective chart review of children with Missouri Medicaid presenting to a single site between January 1, 2018 and December 31, 2018 was conducted. Low-acuity patients with common diagnoses were included. Over-the-counter medications prescribed, the cost of prescriptions, the time spent in the emergency department, provider care time, patient age, and the month of visit were extracted. Data were analyzed with descriptive statistics and t tests. RESULTS: Approximately 37% of children were prescribed over-the-counter medications, most commonly antipyretics. When comparing visits in which an over-the-counter medication was prescribed to visits without an over-the-counter medication prescription, we found no significant difference in the associated charges, total time in the department, and provider care time. CONCLUSION: Over-the-counter medications were prescribed for more than one-third of children cared for in the pediatric emergency department for low-acuity presentations. These visits may represent a substantial area for Medicaid access barriers, system redesign, and cost savings.

An open book: A virtual book club designed to connect advanced practice registered nurses through quality improvement.

ABSTRACT: A virtual book club (VBC) was created for advanced practice registered nurses (APRNs) to foster engagement, connect with peers, and apply readings to their personal and professional development. Microsoft Teams virtual platform was used. Books chosen focused on professional development and health care-related topics. As a quality-improvement project, 60 participants completed an anonymous Likert-scale survey about their perception of the VBC. Respondents survey completion rate was 71%. Sixty survey evaluations stated that they agreed or strongly agreed (mean 4.78-4.82/5) that the VBC encourages peer engagement, professional applicability, intention to read professional books, and willingness to invite peers to future VBCs. Participants were neutral (mean 3.25/5) about reading professional or health care-related books outside of the VBC. Virtual book clubs offer opportunities for APRNs to socially connect with peers and apply readings to both their personal and professional development. The results from this project may be applied to help encourage connection with other APRNs during these times of provider burnout.