Download Team Lead Call 6 slides

Using Antibiotics Wisely
Team Lead Call #6
Diane Liu, MD
Assistant Professor, Pediatrics
Co-Director, UPIQ
Agenda
• Follow-up discussion regarding Influenza
• Update on data for all measures
• Educational materials samples
Questions
• Is the nasal live influenza vaccine (LAIV) just as effective or less
effective than the inactivated influenza vaccine?
• Should we as physicians recommend nasal or IM flu vaccine this year?
• An update on local antibiotic resistance
• An update on recommended empiric agents for urinary pathogens
Appropriate Treatment for Children with Pharyngitis
100%
(782/793)
(9/9)
(108/110)
(707/793) (97/110)
80%
(70/104)
(21/32)
20%
88.2%
65.6%
89%
100%
67.3%
0%
(0/2)
6.5%
(41/782) (7/108)
5.2%
40%
98%
98.6%
60%
0%
Appropriate testing for FU throat Cx for negative Advice given to stop Abx
children with pharyngitis
rapid strep test
Baseline
May
(N)
Negative rapid test with
positve Cx FU
1st Line Abx use
Appropriate Treatment for children with URI
100%
(1055/1081)
251/256)
80%
60%
97.6%
98%
(9/26)
40%
34.6%
20%
(1/5)
20%
0%
No Abx prescribed
Snap prescription
Baseline
May (N)
Rational Documentation
Baseline
If antibiotic prescribed, was there a rationale documented?
Cough 782.6
465.9 Acute, URI
None documented
Respiratory Infection 519.8
ears look questionable and family is traveling SNAP
Going out of town and with sorethroat symptoms and otalgia with red ear antibiotic given as snap rx.
16-year-old female with likely acute bronchitis that is viral in nature. She is in no red flags on exam.
Supportive management has been discussed. However symptoms persist or worsen she may fill the
antibiotic prescription for possible pertussis versus w
Your child's rapid strep test was negative. He has been exposed to Strep throat and may still be at risk
for developing this infection. If he has fever, worsening sore throat or pain with eating, this may be signs
of strep throat. If your child develops t
1. Asthma exacerbation - 493.92 (Primary)
2. Cough - 786.2
3. Upper respiratory infection - 465.9
Otalgia of left ear - 388.70
Dizziness - 780.4
Upper respiratory infection - 465.9
Upper respiratory infection - 465.9
Upper respiratory infection 465.9
Fever - 780.60
Asthma Exacerbation 493.92
URI 465.9
URI, acute 465.9 (Primary)
522.4 DENTAL INFECTION
SNAP Med
SNAP Med
SNAP Med
No reason identified
SNAP prescription. child had some ear ache
Written as a SNAP
Child had a diagnosis of 490- Bronchitis antibiotic given for that
May
If antibiotic prescribed, was there a rationale documented?
None documented
None documented
Discussed with parent and patient that symptoms are likely viral in
nature however symptoms do progress, she may fill a safety net
antibiotic prescription in 5 days. ER and follow up precautions have also
been reviewed.
None documented
None documented
Appropriate Treatment for Children with AOM
100%
(112/114)
(652/680)
(23/25)
(529/652)
80%
(87/112)
(80/123)
(28/652)
(8/112)
7.1%
92%
65%
77.7%
81.1%
98.2%
20%
4.3%
40%
95.8%
60%
0%
Abx given to children with AOM
SNAP
1st line Abx use
Baseline
June (N)
Reasonable Rationale
Documentation
Appropriate Treatment for Children with Sinusitis
100%
(159/163)
(44/44)
(27/28)
(131/159)
(36/44)
80%
(5/8)
(1/44)
2.3%
8.8%
20%
62.5%
(14/159)
96.4%
40%
81.8%
82.4%
100%
97.5%
60%
0%
Abx given to children with Sinusitis
SNAP
1st line Abx use
Baseline
June (N)
Reasonable Rationale
Documentation
July Data
Practice
Children with pharyngitis
Children with URI
Blanding
Missing
Missing
Comfort Care
Missing
Missing
Granger Fam Med
Missing
Missing
Granger Peds
Missing
Missing
Granger Urgent Care
Missing
Missing
South Jordan
Missing
Missing
South Main
Submitted
Submitted
UPC
Submitted
Submitted
Missing
Missing
UVP Timpanogos
Submitted
Submitted
Village Green
Submitted
Submitted
UVP North
% of visit Dx used that would "rationalize" using an antibiotic vs those for which no antibiotic would be appropriate
100%
80%
60.2%
59.7%
58.9%
58.1%
56.3%
39.8%
40.3%
41.1%
41.9%
43.8%
32.5%
37.3%
67.5%
32.2%
62.7%
67.8%
31.3%
35.9%
68.8%
30.4%
64.1%
69.6%
28.0%
35.6%
72.0%
26.8%
64.4%
73.2%
26.1%
35.5%
73.9%
23.8%
64.5%
76.2%
60%
40%
20%
0%
Yes (antibiotic warranting Dx)
No (Dx where no antibiotic would be appropriate)
% of primary visit Dx used that would “rationalize” using an antibiotic vs. those for which no antibiotic would be appropriate
Primary diagnoses that would
“rationalize” using an antibiotic
Primary diagnoses for which no
antibiotic would be appropriate
34.3%
65.7%
Dx
ICD
N
Acute pharyngitis
462
277
Pneumonia, organism unspecified 486
51
Streptococcal sore throat
034.x
101
Suppurative & unspecified otitis
media
382.xx
304
Acute sinusitis
461.x
56
N
Y
Dx
Unspecified viral infection
Croup
Fever
Otalgia
Acute upper respiratory infection
Acute bronchiolitis
ICD
N
079.99
464.4
780.60
388.7x
465.x
466.1x
125
68
286
76
792
165
Viral Infection
Name:____________________________
Diagnosis:

Cold/cough

Middle ear fluid

Bronchitis

Other _________________

Sore throat
Date: ___/____/____
You have been diagnosed with an illness caused by a virus. Antibiotic treatment does not help viral infections.
If given when not needed, antibiotics can be harmful. The treatments prescribed below will help you feel better while your body’s own defenses are
defeating the virus.
General Instructions:  Get plenty of rest
 Stay away from smoke
 Drink plenty of fluid
 Soothe throat with ice chips
 Use a humidifier or saline nasal spray to relieve congestions
 Other ________________
Medications:
 For pain and fever: Children's Tylenol or Children’s Motrin
For children < then 2 years of age:
Ibuprofen, Advil, Motrin
Acetaminophen, Tylenol
AGE/WEIGHT
(weight is more accurate)
Infant Acetaminophen
Oral Suspension 160mg/5ml
 0-3 months/6-11 lbs.
¼ tsp. (1.25 ml)
AGE/WEIGHT
(weight is more accurate)
Children’s Suspension
100mg/5ml
 6-11 months/12-17 lbs.
½ tsp. (2.5 ml)
 4-11 months/12-17 lbs.
½ tsp. (2.5 ml)
 12-23 months/ 18-23 lbs.
1 tsp. (5.0 ml)
 12-23 months/ 18-23 lbs.
¾ tsp. (3.75 ml)
 For cough: __________________________
Follow-up:
 If your illness does not improve in _____ days, or if you have new symptoms or other concerns, please call or return to the
practice.
 Other: _____________________________________________________________________________
Doctor’s signature: __________________________
Date: ___/___/_____
Next OLS #7
Sexually Transmitted Diseases
Thursday September 17, 2015
12:30p.m to 1:30 p.m.
Susan Keeshin, MD