Collaborating for Community Health: Updating Care for Conjunctivitis

Purpose: A collaborative effort was undertaken in a large primary care system to align with current guidelines for management of viral conjunctivitis from the Center for Disease Control and Prevention and the American Academy of Ophthalmology as well as the promotion of antibiotic stewardship.

Description: Research indicates that most cases of conjunctivitis (pink eye) are caused by a virus and are typically a self-limiting illness, which means prescription antibiotic treatment is ineffective and unnecessary (O’Brien, Heng, McDonald, & Raizman, 2009; Holz et al., 2017, American Academy of Ophthalmology, 2017). The expectation for antibiotics to cure a viral infection leads to increased costs and delays in returning to work, school, and day care. Unnecessary prescribing of antibiotics leads to antibiotic resistance and gives a false sense of hope to patients who believe it will effectively treat the infection (Holz, et al., 2017). Research and society guidelines showed current practice of prescribing topical antibiotics in outpatient nurse protocols for conjunctivitis was not consistent with recommendations. Advising absence from school, day care, and/or work until improved is not a requirement, unless secretions cannot be managed.
An update in care processes was needed to align with the evidence and state department of health recommendations for the treatment of conjunctivitis. This update required collaboration with multiple state health agencies and schools with widespread communication to the public about this practice change. Communication was vital to ensure alignment with and understanding of best practice for conjunctivitis care. During the pre-implementation timeframe, the institution was undergoing a practice convergence process for primary care, which allowed for organizational collaboration. Key stakeholders were identified across the healthcare system and were represented in the project group. Multiple departments and institutional committees were involved in the process. This assisted in achieving internal support for promoting antibiotic stewardship with appropriate prescribing for patients. Additionally, a number of internal resources including guidelines, protocols and electronic health record updates were reviewed and updated by the project group. A multidisciplinary team including public affairs representatives was formed to ensure accurate communication was provided in appropriate timeframes to all stakeholders. A detailed communication plan was developed for consistent messaging including a subgroup that identified patient education materials that required an update to match the practice change. Additional resources were developed to support healthcare providers within and external to the organization.

Evaluation/outcome: The outcome was clear and consistent messaging for care of conjunctivitis to both healthcare providers, patients, and the communities at large with an anticipated decrease in prescribing antibiotics for viral conjunctivitis

Future implication and learnings: It was identified that state legislative changes were needed for approval related to day care rules and standards. Further work is essential to update legislation to reflect the conjunctivitis practice change.