Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
Journal titleBMJ open quality
MetadataShow full item record
AbstractIn 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.
CitationPatel PV, Wallach T, Rosenbluth G, Heyman M, Verstraete S. Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis. BMJ Open Qual. 2022 Mar;11(1):e001616. doi: 10.1136/bmjoq-2021-001616. PMID: 35347066; PMCID: PMC8961161.
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as © 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.
- Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries.
- Authors: Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L
- Issue date: 2013 Jul
- Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: A Secondary Analysis of 2 Randomized Clinical Trials.
- Authors: Poonai N, Powell EC, Schnadower D, Casper TC, Roskind CG, Olsen CS, Tarr PI, Mahajan P, Rogers AJ, Schuh S, Hurley KF, Gouin S, Vance C, Farion KJ, Sapien RE, O'Connell KJ, Levine AC, Bhatt S, Freedman SB, Pediatric Emergency Care Applied Research Network (PECARN) and Pediatric Emergency Research Canada (PERC)
- Issue date: 2021 Apr 1
- Oral ondansetron for gastroenteritis in a pediatric emergency department.
- Authors: Freedman SB, Adler M, Seshadri R, Powell EC
- Issue date: 2006 Apr 20
- The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial.
- Authors: Roslund G, Hepps TS, McQuillen KK
- Issue date: 2008 Jul
- A pragmatic randomized controlled trial of multi-dose oral ondansetron for pediatric gastroenteritis (the DOSE-AGE study): statistical analysis plan.
- Authors: Heath A, Rios JD, Williamson-Urquhart S, Pechlivanoglou P, Offringa M, McCabe C, Hopkin G, Plint AC, Dixon A, Beer D, Gouin S, Joubert G, Klassen TP, Freedman SB, PERC-KIDSCAN DOSE-AGE Study Group
- Issue date: 2020 Aug 24