Cargando…

Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis

In paediatric patients with acute gastroenteritis (AGE), ondansetron use decreases the need for intravenous fluids, reduces hospitalisations and shortens illness duration. Oral rehydration is also known to have excellent outcomes for mild to moderate dehydration secondary to AGE. Although these inte...

Descripción completa

Detalles Bibliográficos
Autores principales: Patel, Perseus Vistasp, Wallach, Thomas, Rosenbluth, Glenn, Heyman, Mel, Verstraete, Sofia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961161/
https://www.ncbi.nlm.nih.gov/pubmed/35347066
http://dx.doi.org/10.1136/bmjoq-2021-001616
_version_ 1784677538120859648
author Patel, Perseus Vistasp
Wallach, Thomas
Rosenbluth, Glenn
Heyman, Mel
Verstraete, Sofia
author_facet Patel, Perseus Vistasp
Wallach, Thomas
Rosenbluth, Glenn
Heyman, Mel
Verstraete, Sofia
author_sort Patel, Perseus Vistasp
collection PubMed
description In paediatric patients with acute gastroenteritis (AGE), ondansetron use decreases the need for intravenous fluids, reduces hospitalisations and shortens illness duration. Oral rehydration is also known to have excellent outcomes for mild to moderate dehydration secondary to AGE. Although these interventions are recommended in guidelines from international professional societies, baseline data at our clinic showed that <2% of these patients were offered ondansetron, and that few patients received appropriately detailed rehydration instructions. Therefore, we engaged residents and fellows as teachers and leaders in our university clinic’s quality improvement programme to promote evidence-based practice for paediatric AGE. Our gap analysis identified opportunities for interventions including educating paediatricians and paediatrics residents on the safety and utility of the medication. We created standardised oral rehydration after-visit instructions and implemented a trainee-led educational approach that encouraged appropriate medication use. We used a follow-up survey to uncover provider concerns and tailor future interventions. The process metrics included: proportion of paediatric patients appropriately treated with ondansetron (goal of 80%), and proportion of patients given appropriate oral rehydration instructions. The outcome metric was 7-day representation rates. To achieve sustainability, we restructured our process to have senior residents take ownership of teaching and data collection. Trainee-driven interventions increased ondansetron prescription rates to a median of 66.6%. Patients prescribed ondansetron were less likely to represent to care, although representation rate was low overall. Postintervention data suggests that prescription rates decreased without continued interventions and additional systems redesign may help sustain impact.
format Online
Article
Text
id pubmed-8961161
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-89611612022-04-11 Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis Patel, Perseus Vistasp Wallach, Thomas Rosenbluth, Glenn Heyman, Mel Verstraete, Sofia BMJ Open Qual Quality Improvement Report In paediatric patients with acute gastroenteritis (AGE), ondansetron use decreases the need for intravenous fluids, reduces hospitalisations and shortens illness duration. Oral rehydration is also known to have excellent outcomes for mild to moderate dehydration secondary to AGE. Although these interventions are recommended in guidelines from international professional societies, baseline data at our clinic showed that <2% of these patients were offered ondansetron, and that few patients received appropriately detailed rehydration instructions. Therefore, we engaged residents and fellows as teachers and leaders in our university clinic’s quality improvement programme to promote evidence-based practice for paediatric AGE. Our gap analysis identified opportunities for interventions including educating paediatricians and paediatrics residents on the safety and utility of the medication. We created standardised oral rehydration after-visit instructions and implemented a trainee-led educational approach that encouraged appropriate medication use. We used a follow-up survey to uncover provider concerns and tailor future interventions. The process metrics included: proportion of paediatric patients appropriately treated with ondansetron (goal of 80%), and proportion of patients given appropriate oral rehydration instructions. The outcome metric was 7-day representation rates. To achieve sustainability, we restructured our process to have senior residents take ownership of teaching and data collection. Trainee-driven interventions increased ondansetron prescription rates to a median of 66.6%. Patients prescribed ondansetron were less likely to represent to care, although representation rate was low overall. Postintervention data suggests that prescription rates decreased without continued interventions and additional systems redesign may help sustain impact. BMJ Publishing Group 2022-03-28 /pmc/articles/PMC8961161/ /pubmed/35347066 http://dx.doi.org/10.1136/bmjoq-2021-001616 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Patel, Perseus Vistasp
Wallach, Thomas
Rosenbluth, Glenn
Heyman, Mel
Verstraete, Sofia
Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
title Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
title_full Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
title_fullStr Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
title_full_unstemmed Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
title_short Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
title_sort improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961161/
https://www.ncbi.nlm.nih.gov/pubmed/35347066
http://dx.doi.org/10.1136/bmjoq-2021-001616
work_keys_str_mv AT patelperseusvistasp improvingondansetronuseandoralrehydrationinstructionsforpediatricacutegastroenteritis
AT wallachthomas improvingondansetronuseandoralrehydrationinstructionsforpediatricacutegastroenteritis
AT rosenbluthglenn improvingondansetronuseandoralrehydrationinstructionsforpediatricacutegastroenteritis
AT heymanmel improvingondansetronuseandoralrehydrationinstructionsforpediatricacutegastroenteritis
AT verstraetesofia improvingondansetronuseandoralrehydrationinstructionsforpediatricacutegastroenteritis