mips measure #65 | appropriate treatment for children with uris

#65: Appropriate treatment for children with upper respiratory

infections

Antibiotics are not recommended in children with simple URI’s

#65Appropriate treatment for Pediatric URI

#65Appropriate treatment for Pediatric URI

• Inappropriate Antibiotic Prescriptions for URI, Bronchitis and Pharyngitis are estimated to account for 55% of all antibiotics prescribed for URIs in Pediatrics, possibly as high as 80% in adults.

• Avoiding Antibiotics for apparently viral respiratory illness is an American Academy of Pediatrics Choosing Wisely Campaign Initiative

• Avoiding antibiotics for Simple Acute Bronchitis is a CDC recommendation

#65: Appropriate Treatment of Pediatric URI(Inclusion)

Numerator:Patients not prescribed or dispensed antibiotics within 3 days after date of service in the ED.

Denominator:1. Age 3 months – 18 years old2. Diagnosis of Upper Respiratory

Infection

For Pediatrics, only 3 diagnosis codes:1. Acute Nasopharyngitis/Common Cold2. Acute Laryngopharyngitis3. Acute Upper Respiratory Infection

#65Appropriate treatment for Pediatric URI

#65Exclusion

• Alternate infection documented (Sinusitis, UTI, other)

• Antibiotic within previous 30 days documented.

Best PracticesAs always, documentation is the key!

Best practice:1. Avoid antibiotics in children with simple upper respiratory infections and adults with simple bronchitis.

2. Children: “Patient with URI complicated by otitis media, Amoxil prescribed.” (excluded).

3. Children: “Patient with cystic fibrosis. URI discussed with pediatrician and antibiotic prescribed.” (excluded)

Not Acceptable:1. “Patient with prolonged cough, will treat with Zithromax for ongoing bronchitis.”

2. “Patient with acute bronchitis with bronchospasm, and states ‘I always get an antibiotic’, will treat with Amoxicillin.” (Although not evidence based, the measure would be met if antibiotic not prescribed within 3 days of encounter: “Patient insists on antibiotic as no PMD, After discussion, prescription written for Amoxil to be filled in 4 days if symptoms persist.”)