• Gary L McPhail, Jeanne Weiland, James D Acton, Mathew Ednick, Amrita Chima, Rhonda VanDyke, Matthew C Fenchel, Raouf S Amin, and Michael Seid.
• Division of Pulmonary Medicine, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. gary.mcphail@cchmc.org
• Arch Pediatr Adolesc Med. 2010 Oct 1; 164 (10): 957-60.

ObjectiveTo increase clinician adherence to prescribing guidelines for pulmonary medications in children with cystic fibrosis (CF).DesignQuality improvement project with multiple time series design.SettingThe CF center at a tertiary care pediatric hospital in the United States.PatientsChildren with CF who were eligible to receive oral azithromycin, nebulized dornase alfa, or inhaled tobramycin sulfate based on prescribing guidelines for CF lung disease.InterventionEvidence-based prescribing guidelines were designed by a local committee to reflect consensus recommendations from the CF Foundation. Clinicians and families were educated about guidelines. Adherence to prescribing guidelines was tracked using a local CF database and record reviews. Weekly meetings were used to highlight adherence failures and promote clinician accountability.Main Outcome MeasureThe rate of clinician adherence to prescribing guidelines.ResultsOne hundred seventy patients with CF were included. At the start of the project, the rate of clinician adherence to prescribing guidelines was 62%. After 3 months of the project, the rate of clinician adherence to prescribing guidelines was 87% (odds ratio = 4.6; 95% confidence interval, 3.0-7.0). The improvements in adherence to prescribing guidelines were sustained for 21 months of follow-up.ConclusionsEducating clinicians about prescribing guidelines, sharing guidelines with families, and monitoring clinician adherence improve prescribing adherence to evidence-based recommendations.

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