METHODS: Based in a large academic general pediatrics practice, this project targeted patients with eczema who presented for 4-6 month well-child visits. Following a 4 week audit period, a clinic-specific protocol was developed. Over the course of 6 cycles (1 week/cycle), several strategies were employed to assist in implementation of these guidelines.
RESULTS: In the audit period, the guidelines were implemented in 0% of patients. Despite interventions the first 3 cycles (email to providers, 5-minute presentation to small groups, another condensed email), implementation of guidelines remained at 0%. Guideline implementation increased to 8% after reminder cards were placed at workstations in cycle 4. Guideline implementation decreased to 0% after home peanut introduction teaching sheets were placed in clinic in cycle 5. Guideline implementation increased to 17% after real-time clinic assistance by an allergist in cycle 6.
CONCLUSIONS: While the newest guidelines for the prevention of peanut allergy simplify the approach to patients at risk for developing a peanut allergy, real-life application in a general pediatrics practice is challenging. Time constraints and provider confidence in administering new counseling are possible roadblocks. To help implementation of new guidelines, a more concrete change in workflow and further education is likely required.