1. Using Antibiotics Wisely Team Lead Call #6 Diane Liu, MD Assistant Professor, Pediatrics Co-Director, UPIQ

2. Agenda Follow-up discussion regarding Influenza Update on data for all measures Educational materials samples

3. 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

4. (782/793) (7/108) (707/793) (9/9) (0/2) (21/32) (41/782) (108/110) (70/104)

5. (1055/1081)251/256) (9/26) (1/5) (N)

6. 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 Fever - 780.60 Asthma Exacerbation 493.92 URI 465.9 URI, acute 465.9 (Primary) 522.4 DENTAL INFECTION 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 If antibiotic prescribed, was there a rationale 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 Rational Documentation Baseline May

7. (652/680) (28/652) (87/112) (80/123) (N)

8. (159/163) (44/44) (14/159) (1/44) (131/159) (36/44) (27/28) (5/8)

9. PracticeChildren with pharyngitisChildren with URI BlandingMissing Comfort CareMissing Granger Fam MedMissing Granger PedsMissing Granger Urgent CareMissing South JordanMissing South MainSubmitted UPCSubmitted UVP NorthMissing UVP TimpanogosSubmitted Village GreenSubmitted July Data

11. DxICDN Unspecified viral infection079.99125 Croup464.468 Fever780.60286 Otalgia388.7x76 Acute upper respiratory infection465.x792 Acute bronchiolitis466.1x165 DxICDN Acute pharyngitis462277 Pneumonia, organism unspecified48651 Streptococcal sore throat034.x101 Suppurative & unspecified otitis media382.xx304 Acute sinusitis461.x56 % of primary visit Dx used that would “rationalize” using an antibiotic vs. those for which no antibiotic would be appropriate Primary diagnoses for which no antibiotic would be appropriate Primary diagnoses that would “rationalize” using an antibiotic

12. Viral Infection Name:____________________________ Date: ___/____/____ Diagnosis:  Cold/cough  Middle ear fluid  Bronchitis  Other _________________  Sore throat 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: 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: ___/___/_____ AGE/WEIGHT (weight is more accurate) Infant Acetaminophen Oral Suspension 160mg/5ml  0-3 months/6-11 lbs.¼ tsp. (1.25 ml)  4-11 months/12-17 lbs.½ tsp. (2.5 ml)  12-23 months/ 18-23 lbs.¾ tsp. (3.75 ml) AGE/WEIGHT (weight is more accurate) Children’s Suspension 100mg/5ml  6-11 months/12-17 lbs.½ tsp. (2.5 ml)  12-23 months/ 18-23 lbs.1 tsp. (5.0 ml) Acetaminophen, Tylenol Ibuprofen, Advil, Motrin  For cough: __________________________

16. Next OLS #7 Sexually Transmitted Diseases Thursday September 17, 2015 12:30p.m to 1:30 p.m. Susan Keeshin, MD