The following article is part of coverage from the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2020). Due to the global COVID-19 pandemic, the Association made the necessary decision to cancel their meeting originally scheduled for March 25-28, 2020, in Long Beach, CA, and rescheduled the event to a virtual meeting held June 4-5, 2020. Readers can click here to catch up on the latest research.

It has been 7 years since the American Academy of Pediatrics (AAP) implemented a watchful waiting program for the management of acute otitis media (AOM). Despite these updates, the majority of children diagnosed with AOM at the Children’s Mercy Hospital Kansas Emergency Department routinely receive antibiotic prescriptions, according to Alicia Daggett, MD.

To educate staff members about the benefits of watchful waiting, Dr Daggett and colleagues—a multidisciplinary team comprised of an infectious disease physician and pharmacist, emergency department physicians, advanced practice registered nurses, and additional staff nurses—developed a plan to evaluate baseline rates of antibiotic prescriptions for AOM and to ascertain patient eligibility for a watchful waiting approach, according to the study, which was presented virtually at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2020).

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Children diagnosed with AOM at the Children’s Mercy Hospital (n=400) were evaluated from August 2017 and April 2018. Three plan-do-study-act (PDSA) cycles were implemented. The first, in August 2018, summarized the treatment recommendations provided in the AAP AOM guidelines and presented the guidelines in the emergency department workroom to help inform clinicians about eligible patients for the watchful waiting program. For the second PSDA cycle, providers who discussed watchful waiting with families were recognized through a monthly email starting in December 2018. A third PSDA cycle in October 2019 standardized electronic prescriptions for AOM antibiotics.

A total of 34% of eligible patients could have been offered watchful waiting based on the recommendation guidelines; however, providers discussed watchful waiting with only 0.8% of those patients. Following the first PSDA cycle, an immediate improvement in watchful waiting was seen. The conversation of watchful waiting among patients and parents increased from 0.8% to 5% in September 2018; that rate improved further to 8.5% in January 2019 after the second PSDA cycle.

Providers have consistently discussed watchful waiting and offered SNAP to at least 5% of eligible patients each month since the start of the project. There have been no reported ruptured tympanic membranes or increase in return visit rates within 14 days of offering watchful waiting.

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“Cleary, there is need to increase the number of patients who can utilize the watchful waiting with SNAP treatment option,” the authors concluded. This improvement can be achieved using continued education with reinforcement in future PDSA cycles.”

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Daggett A, Phillips P, Burns A, Lee BR, Shastri NJ, Feghaly RE. Optimizing antibiotic management of pediatric acute otitis media in an emergency department. Presented virtually at: NAPNAP 2020; June 4-5, 2020. Abstract W17.