A recent study suggested that urgent care centers have a high rate of inappropriate antibiotic prescribing. Inappropriate antibiotic use not only contributes to antibiotic resistance but also places patients at risk for adverse drug reactions and drug side effects. While recognition of this issue is increasing in the outpatient and specifically urgent care centers, little has been done to examine the problem specifically in the pediatric urgent care setting. Furthermore, identifying unique barriers to appropriate antibiotic prescribing for the pediatric provider in the acute care setting will allow for improvement initiatives to succeed.
The aims of our quality improvement study are threefold: firstly, to build capacity for implementing quality improvement projects at both the local and multi-institutional level in pediatric urgent cares; secondly, to understand the antibiotic prescribing patterns in pediatric urgent cares; and thirdly, to implement a randomized cluster trial of interventions to reduce inappropriate antibiotic prescribing by 20% from baseline values.
The Society for Pediatric Urgent Care (SPUC) recruited over 100 individual providers and over 20 organizations. A pre-implementation survey of providers was conducted on awareness and attitudes. A total of 156 providers completed the survey; 114 (73%) were board certified pediatricians, 15 (9.6%) were board certified emergency medicine physicians, 12 (7.7%) were family nurse practitioners, 10 (6.4%) were pediatric nurse practitioners, and 2 (1.3%) were physician assistants.
The options provided to answer “What are the barriers to appropriate prescribing for acute respiratory infections” included patient expectations, psychosocial barriers, lack of clear evidence-based recommendations and lack of access to guidelines on prescribing.
Baseline data collection on patient demographics, past medical history, and antibiotic information has begun. Collaboration between ARAC, the CDC and our SPUC researchers is under way to analyze this data. Each organization will be provided with a list of the top diagnoses for which they prescribe antibiotics. They will use these diagnoses to align their QI interventions with their site-specific QI goals.
Each participating institution will then choose and launch three interventions derived from the CDC’s MITIGATE ("Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings") toolkit (i.e., provider education, communication training, public engagement/awareness, discharge education, and delayed prescribing). After each intervention cycle, plan-do-study-act (PDSA) data will be collected and will include patient demographics, all other ICD_10/SNOMED, healthcare information, and antibiotic prescription information. Data will be abstracted into a REDCap database, with data being analyzed by the Antibiotic Resistance Action Center (ARAC) and reviewed by subject matter experts. All organizations will receive feedback in the form of run charts looking at inappropriate antibiotic prescribing.
The PDSA cycles will run through the summer and into fall. Final data analysis and presentation of the data will occur in early 2020. Pediatric physicians will be able to obtain Part IV MOC with the American Board of Pediatrics.
September 26-29, 2019
Cook Children's Medical Center
Fort Worth, Texas
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