Antibiotic prophylaxis in cesarean section: use of cost per case comparison to influence prescribing practices

Results of a previously conducted DUE revealed that 91% of obstetric patients received antibiotic prophylaxis with cefoxitin despite the existence of obstetric department guidelines recommending the use of cefazolin. In the present DUE, antibiotic selection in C-section prophylaxis was reviewed and individual prescribers, both compliant and noncompliant with guidelines, were identified. Over a 2-month period, physicians who prescribed other than cefazolin for C-section prophylaxis were issued "Dear Doctor" letters, reminding them of existing guidelines. A significant change in prescribing patterns following this intervention was not demonstrated. A multidisciplinary approach was then undertaken. Prescribers were stratified by number of procedures, antibiotic requested, and antibiotic cost per case (average and median). Results were reviewed with Co-chiefs of Ob/Gyn. Letters to both compliant and noncompliant prescribers were issued. A grand rounds presentation describing the results of the DUE was also given. A follow-up review showed that the conversion to cefazolin prophylaxis reached 80%, with accompanied extrapolated yearly cost avoidance of nearly $5,500.