educational series | acute otitis externa (aoe): topical therapy & systemic antimicrobial...
TRANSCRIPT
11 measures Antibiotic
Stewardship• #66: Pharyngitis patients
given an abx who had strep test performed
• #91: Patients with Otitis Externa given a topical abx
• #93: Patients with Otitis Externa not given a systemic abx
• #116: 18-64 y/o with bronchitis not given abxwithin 3 days of encounter
Choosing Wisely:Head CT Utilization
• #416: 2-17 y/o with appropriate head CT for blunt head trauma (PECARN rules)
• #415: 18+ y/o with appropriate head CT ordering for blunt head trauma
PregnancyMeasures
• #254: US localization of pregnancy in pregnant pts with abd pain
• #255: Rhogam for Rh negative patients at risk
Miscellaneous
• #54: EKG for non-traumatic chest pain
• #76: Proper sterile technique for CVC placement
• #317: BP Screening and follow up documented
#91 Acute Otitis Externa (AOE): Topical Therapy
AND
#93 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy
Week 4
#91:Acute Otitis Externa (AOE): Topical Therapy
Percentage of patients prescribed a topical
preparation forAcute Otitis Externa
#91:Acute Otitis Externa (AOE): Topical Therapy
Simple otitis externa should be treated with
topical preparations alone
Clinical Practice Guideline by the American Academy of
Otolaryngology-Head andNeck Surgery
#91:Inclusion
Numerator:Patients prescribed (or currently taking) a topical preparation for AOE
Denominator:1. Patients > 2 years old2. Patients diagnosed with AOE
#91:Exclusions: (measure is not coded/does not apply)
1. Coexisting Otitis Media or other infectious process (and systemic antibiotics ordered)
2. Ruptured Tympanic Membrane (although non ototoxic preparation such as fluoroquinolone may be used)
3. Documented patient reason such as patient not capable of compliance (would be uncommon situation)
#91:Note
Realize the only requirement here is ordering a topical
preparation, which doesn't need to be an antibiotic and can be
OTC (such as acetic acid).
Best PracticesAs always, remember good documentation!
Best practice:1. “Patient with simple otitis externa, cortisporin prescribed.”
2. “Patient with otitis media, systemic antibiotic prescribed.” (this would be an exclusion of the measure, and one may prescribe a topical preparation in addition to the systemic antibiotic)
Not Acceptable:1. No topical agent given without documentation of valid reason.
#93:Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy
Systemic antibiotics are not recommended in cases of
uncomplicated otitis externa.
#93:Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy
Avoiding systemic antibiotics in AOE is included in the Choosing
Wisely Campaign for the American Academy of
Otolaryngology-Head andNeck Surgery
AAO-HNS Choosing Wisely List
#93:Inclusion
Numerator: Patients with simple AOE who are not prescribed systemic antibiotic therapy
Denominator:1. Patients > 2 years old2. Patients diagnosed with AOE
#93:Exclusion: Medical Reason Documented
1. Other infection documented (for example cellulitis, otitis media, pharyngitis)
2. OE is complicated (cellulitis, foreign body)
3. Immunocompromised (Diabetes, immune deficiency)
#93:Note
Physician judgment is most important. If a systemic
antibiotic is needed, clearly document the reason and you
should be in good shape.
Best PracticesAs always, documentation is the key!
Best practice:1. “Patient with simple otitis externa, no oral antibiotic indicated.”2. Not prescribing systemic antibiotic without comment is acceptable.3. “Patient with poorly controlled diabetes mellitus, Keflex prescribed in addition to Cipro Otic
drops.” (Exclusion)
Not Acceptable:1. “Patient with severe pain and oral antibiotic prescribed.”2. Oral antibiotic given without reason.