A Pilot Project to Understand Prescribing Practices of Otitis Media with Effusion

Abstract

Otitis media is one of the most common reasons for pediatric healthcare visits and a common reason for inappropriate prescribing of antibiotics. Otitis media is differentiated into two categories: acute otitis media (AOM) and otitis media with effusion (OME). OME is characterized by reduced tympanic mobility and middle ear effusion without signs of acute inflammation or infection. Approximately 80% of children will have experienced at least one episode of otitis media by their third birthday. The clinical practice guideline for managing otitis media with effusion was updated in 2016. This guideline supports three months of watchful waiting from start of symptoms or date of diagnosis over the use of antibiotics. Problem: Providers continue to use antibiotics for the treatment of OME in the presence of published guidelines. Project Aim: The purpose of this project was to understand prescribing practices among health care providers in the diagnosis, treatment and management of OME through the use of a descriptive survey. Donabedian’s Quality Framework and structure process outcome model guided the project. Project Method: A convenience sample of advanced practice registered nurses (APRNs) and physicians from three area suburban urgent cares were surveyed regarding their knowledge of the current guidelines and factors associated with adherence to prescribing practice guidelines. Results: The majority of providers recognized a middle ear effusion as a sign of an OME, however, less than half identified all other potential signs of OME. It was also found that a variety of diagnosis codes were used to document an OME or AOM. Recommendations included provider education on inclusion and exclusion criteria for OME diagnosis and using standardized diagnosis codes for AOM and OME in the urgent cares. These results will direct provider education on OME and antibiotic stewardship in the urgent cares. Keywords: Otitis media, OME, antibiotics, prescribing practices, quality improvement