Diagnosis and management of otitis media with effusion in a tertiary hospital in Kano: a best practice implementation project.

OBJECTIVE: To implement the best available practice to improve the diagnosis and management of OME according to best available evidence at the Aminu Kano Teaching Hospital, Kano, Nigeria.

INTRODUCTION: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear, without signs and symptoms of an acute infection. It has high rates of physician visits and is a common cause of hearing impairment in affected children. In Nigeria, the prevalence is estimated to range from 8% to 25.2%.

METHODS: The current quality improvement project was conducted using the Joanna Briggs Institute approach for clinical audits, involving a baseline audit, an implementation of change phase and a follow-up audit, using Practical Application of Clinical Evidence System software. Eleven evidence-based audit criteria were used for this project. The same audit criteria were used for the baseline and follow-up audit. The sample size was 20 for both the baseline and follow-up. Implemented change involved the introduction of pneumatic otoscope use in the department and educational sessions with clinicians and caregivers. The project was conducted from July to November 2017.

RESULTS: Implementation of strategies to improve practice led to large increases in compliance with audit criteria, particularly Criteria 1, 6, 9 and 10 (from 0-25% to 70-100%). Paradoxically, a decrease in compliance was observed for two criteria.

CONCLUSION: The current project succeeded in increasing clinician compliance with best available evidence. The most significant evidence-based change seen was in the use of pneumatic otoscope, whereas the most difficult barrier to overcome was resistance to change.