P3.227: Prescription for Success: Improving Antibiotic Counseling at Hospital Discharge

Background: Currently, no standardized antibiotic counseling curriculum exists for pediatric residents. Medication counseling is a key component of discharge teaching, yet few studies in the U.S. have explored the impact of antibiotic counseling and adherence in pediatric patients post-discharge. A recent qualitative study revealed caregivers’ poor understanding of prescribed medications and desire for more education, while providers felt uncomfortable with counseling. Multimodal teaching methods have been shown to improve comprehension, adherence, and error rates in pediatric emergency settings. This project seeks to assess whether educating pediatric residents increases their comfort, knowledge, and counseling efforts. Although all providers contribute to patient education, this initiative targets residents who lead bedside discharge teaching.

Methods: Six commonly prescribed antibiotics (amoxicillin, amoxicillin/clavulanate, azithromycin, cephalexin, clindamycin, and trimethoprim/sulfamethoxazole) were selected for the curriculum. Antibiotic counseling quick sheets for providers, specific antibiotic handouts for caregivers in English and Spanish (Figure 1), and a 12-item counseling observation checklist were developed. Before the intervention, pediatric residents at an academic tertiary care children’s hospital completed a survey assessing counseling practices and attitudes (via Likert scale) and antibiotic knowledge (via multiple choice test questions). Supervising physicians observed counseling by residents in clinical practice. Residents then participated in a didactic session and a communication simulation for the intervention. Afterwards, residents completed a second survey and were re-observed by supervising physicians. This curriculum follows Miller’s Pyramid of Clinical Competence, with the didactic session (Knows), simulation session (Shows How), and real-world evaluation (Does), and aligns with the Kirkpatrick Model for Training Evaluation, primarily targeting Learning and Behavior.

Results: Of 69 residents, 92% (n=64) attended the didactic session, and 84% (n=58) participated in the simulation. Ninety-one percent (n=63) completed the pre-survey, and 69% (n=48) completed the post-survey. Fifty percent of residents were observed in clinical practice. Post-intervention, residents reported significantly increased comfort with antibiotic counseling, rising from 18% (n=9) to 100% (n=48). Knowledge scores improved across all 14 questions. Survey results showed a notable increase in counseling effort, with 83% (n=40) of residents discussing seven or more key counseling points compared to 55% (n=35) before the intervention. Additionally, more residents reported providing counseling in over half of patient encounters following the intervention. Clinical practice observations also reflected an increase in counseling effort, both overall and by specific counseling item (Figure 2).

Conclusion: The introduction of a novel antibiotic counseling curriculum incorporating didactic and simulation sessions improved pediatric residents' comfort, knowledge, and counseling efforts. Future steps include expanding the curriculum to cover additional antibiotics and extending education to hospitalist faculty and other interdisciplinary departments. Further research is needed to explore caregiver perspectives and evaluate the impact of this education on patient antibiotic adherence.