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EQIPP: Judicious Use of Antibiotics

ACCME Accreditation Statement(s)

Enduring Material

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AAP designates this enduring material for a maximum of 9.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This program is accredited for 9.0 NAPNAP CE contact hours of which 2.75 contain pharmacology (Rx), (0 related to psychopharmacology) (0 related to controlled substances), content per the National Association of Pediatric Nurse Practitioners Continuing Education Guidelines.

The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME. Physician assistants may receive a maximum of 9.0 hours of Category 1 credit for completing this program.

This activity is acceptable for a maximum of 9.0 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

Track 1 – Upper Respiratory Tract Infection (URI)

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AAP designates this PI CME activity for a maximum of 20 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This program is accredited for 20 NAPNAP CE contact hours of which 0 contain pharmacology (Rx), (0 related to psychopharmacology) (0 related to controlled substances), content per the National Association of Pediatric Nurse Practitioners Continuing Education Guidelines.

The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME. Physician assistants may receive a maximum of 20 hours of Category 1 credit for completing this program.

This activity is acceptable for a maximum of 20 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

Track 2 – Acute Otitis Media (AOM)

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Track 3 – Acute Streptococcal Pharyngitis (strep throat)

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Track 4 Acute Bacterial Sinusitis

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Course Goals

The goal of this EQIPP Judicious Use of Antibiotics course is to help you create plans for improvement and to address gaps identified in key activities of clinical care related to diagnosing and treating common pediatrics infections. These activities focus on improving ongoing medical care and patient/family education and support. You will collect baseline and follow-up data as you work to improve care and processes through Plan, Do, Study, and Act (PDSA) cycles.

Learning Objectives

Be familiar with the following guidelines and recommendations:
- Judicious Use of Antibiotics:
  - Hersh AL, Jackson MA, Hicks LA, et al Principles of judicious antibiotic prescribing for bacterial upper respiratory tract infections. Pediatrics. 2013;132(6)
  - Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention Web site. 2013. Accessed January 15, 2016
- Clinical Guidelines For Common Infections:
  - Lieberthal AS, Carroll AE, Chonmaitree T, et al. AAP Clinical Practice Guideline: The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3);1451–1465
  - Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guide for diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. 2012. Accessed January 15, 2016
  - Wald ER, Applegate KE, Bordley C, et al. AAP clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children Aged 1 to 18 years. Pediatrics. 2013;132;e262–e280
Recognize how the key activities identified in this course contribute to the ongoing judicious use of antibiotics for treating patients with common pediatrics infections.
Be able to implement ideas for change to help you do the following:

Accurately diagnose common pediatric infections, including upper respiratory infection (URI), acute otitis media, acute bacterial sinusitis, and group A streptococcal pharyngitis to ensure appropriate and effective treatment.
Differentiate between viral and bacterial infections.
Make treatment decisions for these infections based on accurate diagnoses.
Treat patients effectively, using antibiotics only when indicated and using the correct antibiotic.
Avoid misuse of antibiotics by not treating patients when antibiotics have no benefit.
Prescribe narrow-spectrum antibiotics versus broad-spectrum antibiotics when viable to limit antibiotic resistance and unnecessary healthcare costs, while maintaining high-quality care.
Provide information to patients and families about the benefits and risks of antibiotic use.
Provide guidance and education to patients and families about the benefits of judicious use of antibiotics for mitigating antibiotic resistance and adverse events for patients.
Respond effectively to patients and families when unnecessary antibiotics are requested.
Assess the diagnostic and prescribing patterns of your practice.

In this course, you will use baseline practice measurements to identify opportunities to judiciously prescribe antibiotics for common pediatric conditions through Plan, Do, Study, Act (PDSA) cycles.

Disclosure of Commercial Support for AAP CME Activities

The EQIPP: Judicious Use of Antibiotics course is supported by an educational grant from GlaxoSmithKline, LLC.

Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities Grid

The AAP CME/CPD program develops, maintains, and improves the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The AAP CME/CPD program strives to meet the educational needs of pediatricians and pediatric healthcare professionals and support their lifelong learning with a goal of improving care for children and families. (AAP CME/CPD Program Mission Statement, May 2015)

The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The &"AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.

All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.

The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.

Activity Title:	EQIPP: Judicious Use of Antibiotics
Activity Location:	Online
Activity Dates:	April 12, 2016 – April 11, 2020

DISCLOSURE OF FINANCIAL RELATIONSHIPS

All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities. Listed below are the disclosures provided by individuals in a position to influence and/or control CME activity content.

* A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Name	Role	Relevant Financial Relationship (Please indicate Yes or No)	Name of Commercial Interest(s)* Please list name(s) of entity AND Nature of Relevant Financial Relationship(s) (Please list: Research Grant, Speaker’s Bureau, Stock/Bonds excluding mutual funds, Consultant, Other - identify)	Disclosure of Off-Label (Unapproved)/Investigational Uses of Products AAP CME faculty are required to disclose to the AAP and to learners when they plan to discuss or demonstrate pharmaceuticals and/or medical devices that are not approved by the FDA and/or medical or surgical procedures that involve an unapproved or &"off-label” use of an approved device or pharmaceutical. (Do intend to discuss or Do not intend to discuss)
Teri Blommaert	Staff Instructional Designer	No	None	I do not intend to discuss
Katherine Fleming-Dutra, MD	Online Course Reviewer	No	None	I do not intend to discuss
Jennifer Frantz, MPH	Staff	No	None	I do not intend to discuss
Jesse Hackell, MD	Online Course Reviewer	Yes	1. My spouse/partner has a Stocks/Bonds relationship with GSK. Please note: Approximately 300 shares common stock. 2. My spouse/partner has a Stocks/Bonds relationship with Pfizer. Please note: Approximately 300 shares common stock.	I do not intend to discuss
Adam Hersh, MD, PhD	Online Course Reviewer	Yes	I have a Research Grant relationship with Pfizer. Please note: Multiple research grants studying the impact of antibiotic stewardship programs on prescribing patterns for hospitalized patients.	I do not intend to discuss
Lauri Hicks, DO	Online Course Reviewer	No	None	I do not intend to discuss
Mary Anne Jackson, MD	Author	No	None	I do not intend to discuss
Suzanne Kirkwood	Staff	Yes	I have a Stocks/Bonds relationship with Sanofi. I have a Stocks/Bonds relationship with Merck. I have a Stocks/Bonds relationship with Amgen.	I do not intend to discuss
Lori Morawski	Staff/DOI Reviewer/ Resolver	No	None	I do not intend to discuss
Angela Myers, MD, MPG	Author	No	None	No
Linda O’Brien	Staff	No	None	I do not intend to discuss
Theoklis E. Zaoutis, MD, MSCS	Author	No	None	I do intend to discuss unapproved/investigative commercial product/device and will disclose such references to the learner

Commercial Supporters

The EQIPP: Judicious Use of Antibiotics course is supported by an educational grant from GlaxoSmithKline, LLC.

Product-Specific Advertising

No product-specific advertising of any type appears in this activity. No links to product websites appear in this activity.

List of Principal Faculty and Credentials

Mary Anne Jackson, MD, FAAP
Angela L. Myers, MD, MPH, FAAP
Theoklis Zaoutis, MD, MSCE, FAAP

Course Reviewers

Katherine Fleming-Dutra, MD

Jesse Hackell, MD

Adam Hersh, MD, PhD

Lauri Hicks, DO

AAP Staff

Linda O’Brien

Jennifer Frantz, MPH

Suzanne Kirkwood

Lori Morawski, MPH, CHES

Instructional Designer

Teri Blommaert

Name of Medium or Combination of Media Used

Internet course

Method of Physician Participation in the Learning Process

This course is designed to help guide physicians on judicious use of antibiotics based on accurate diagnosis and effective treatment, as well as how to educate families about appropriate antibiotic prescribing. This course features four tracks related to common conditions seen in pediatric patients: acute otitis media, viral upper respiratory infection, acute streptococcal pharyngitis, and acute bacterial sinusitis. Each track will have a specific data collection tool for that condition to assess judicious use of antibiotics in their practice. The course also includes four case studies, assessments, an invitation to create and/or add to My Learning Plan, and a course evaluation.

Estimated Time to Complete the Educational Activity

You should be able to complete this course in 2-4 months.

Instructions for Claiming Credit

• Enduring Material

You may claim 7.0 AMA PRA Category 1 Credit(s)™ after completing this course. In order to complete the course, you must pass the assessment with a score of 70% or greater. Then click on the Claim Credit link in the course and follow the instructions.

• PI CME

After completing the PI CME cycle for activity EQIPP: Judicious Use of Antibiotics Track 1: Upper Respiratory Infection (URI) you may claim 20 AMA PRA Category 1 Credit(s)™. Then click on the Claim Credit link in the course and follow the instructions.

• PI CME

After completing the PI CME cycle for activity EQIPP: Judicious Use of Antibiotics Track 2: Acute Otitis Media (AOM) you may claim 20 AMA PRA Category 1 Credit(s)™. Then click on the Claim Credit link in the course and follow the instructions.

• PI CME

After completing the PI CME cycle for activity EQIPP: Judicious Use of Antibiotics Track 3: Acute Streptococcal Pharyngitis (ASP) you may claim 20 AMA PRA Category 1 Credit(s)™. Then click on the Claim Credit link in the course and follow the instructions.

PI CME

After completing the PI CME cycle for activity EQIPP: Judicious Use of Antibiotics Track 4: Acute Bacterial Sinusitis (ABS) you may claim 20 AMA PRA Category 1 Credit(s)™. Then click on the Claim Credit link in the course and follow the instructions.

Dates of Original Release and Most Recent Review or Revision

Start Date: April 12, 2016 End: April 11, 2019

This course was launched on April 12, 2016. This course will remain online until on April 11, 2020. It will no longer be certified for credit after on April 11, 2020.

Termination Date

This course will remain online until on April 11, 2020. It will no longer be certified for credit after on April 11, 2020.

List of Hardware/Software Requirements

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• Adobe Reader Plug-in (version 6.0 +)

Provider Contact Information

If you have any questions about this course or encounter technical problems, please contact EQIPP at [email protected]. [Subject: EQIPP: Judicious Use of Antibiotics]

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