Management of paediatric otalgia in out-of-hours general practice

Aims: Audit the management, by both general practitioners and nursing staff, of paediatric patients who present with earache and are subsequently diagnosed with otitis media in out-of-hours General Practice. Methods: The standards contained within NICE Clinical Guideline 69, ‘respiratory tract infections’, were measured. A data collection sheet was devised and used for both rounds of audits. Staff were informed of results of the initial audit, and a patient information sheet, also aimed to remind staff, was designed and distributed before the re-audit was conducted. Results: In the initial audit, 25 out of 40 cases (65%) were managed correctly. This increased to 26/40 (70%) for the re-audit sample. Prescription of antibiotics, when not indicated, occurred in 14/40 (35%) and 11/40 (28%) cases respectively. In the re-audit, two patients were issued with deferred prescriptions for antibiotics, one of the guideline recommendations. Diagnostic evidence of otorrhoea in the external auditory canal and/or tympanic membrane perforation were recorded in only 11 out of 40 cases (28%) for the audit and 18 / 40 (45%) for the re-audit. First line recommended amoxicillin was prescribed in virtually all cases, although during each audit, 3 / 40 (8%) cases had no details recorded regarding the type of antibiotic and dosage prescribed. Conclusions: Compliance to NICE guidelines is sub-optimal. Antibiotics are prescribed too often for patients with symptoms of otitis media that have persisted for less than four days. In addition, based on lack of recording in patients, the ears are often not examined rigorously enough. Highlighting this issue to staff, and provision of an educational tool for patients, has led to marginally improved patient management.