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

#116 Avoidance of Antibiotic Treatment in

Adults with Acute Bronchitis

Week 8

#116: Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

Antibiotics are Not Recommended in Patients with Simple Acute

Bronchitis

#116: Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

Avoiding Antibiotics for Simple Acute Bronchitis is a Choosing

Wisely Campaign Recommendation as well as a

CDC recommendation.

#116: Inclusion

Numerator: Patients prescribed antibiotics on or within 3 days of date of service in ED

Denominator:1. Patients age 18-642. Acute Bronchitis diagnosis

#116:Exclusion

1. Alternative infection documented (Sinusitis, UTI, other)

2. Antibiotic within previous 30 days

3. Complicated bronchitis (COPD, bronchiectasis, immunosuppressed)

Best PracticesAs always, remember good documentation!

Best practice:1. Avoid antibiotics in simple bronchitis.

2. “Patient with simple bronchitis, albuterol inhaler prescribed, and antibiotics deferred.”

3. “Patient with bronchitis but HIV+ with fever, Levaquin prescribed.” (Measure is 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.”)