A quality improvement project underway at St. Louis Children’s Hospital has the goal of educating pediatric emergency medicine physicians and nurse practitioners about the benefits of changing the steroid prescribed to patients experiencing an asthma exacerbation.
“For many years it has been common practice to prescribe prednisone to these patients when they are seen in the emergency department,” says Washington University physician Amanda Kopydlowski, MD, a pediatric hospitalist at Children’s. “However, numerous studies have shown that dexamethasone is as effective as prednisone and is a better choice for several reasons.”
First among those reasons is the shorter course of treatment needed with dexamethasone. Prednisone is prescribed for five days. Dexamethasone has a longer half-life and needs to be given for just two days.
“Another advantage is that dexamethasone is given as a tablet, which can be easily crushed up and given in foods such as applesauce,” says Amelia Bray-Aschenbrenner, MD, a Washington University clinical fellow in pediatric emergency medicine. “In contrast, prednisone is given as a large volume of liquid. Some young patients don’t tolerate that well, and that can lead to noncompliance.”
Drs. Kopydlowski and Bray-Aschenbrenner will be holding educational meetings with those in the emergency department who prescribe medications to asthma patients and will use various electronic communications to reach residents. They currently are developing a baseline of how often dexamethasone has been prescribed in the past and will track its usage over the next six months to a year through the Epic software system. Dexamethasone already is included as an option in the hospital’s clinical practice guidelines for treating asthma exacerbations.
“We also will track secondary outcomes such as readmission rates to ensure our patients continue to receive the best care available,” says Dr. Kopydlowski. “There are, in fact, many major children’s hospitals across the country that have already made this change with good results.”
She adds, “We do want community pediatricians to be aware of this change in how we treat asthma exacerbations because they likely will be seeing patients in follow up who are on this new drug prescription protocol. We will be happy to talk with them should they have any questions.”
For more information about the asthma exacerbation quality improvement project, call Children's Direct at 800.678.HELP (4357).
