Adherence to AUA Guidelines for Periprocedural Antibiotics for In-Office Cystoscopy after Implementation of a Simple
N R Swavely1, R A Vince1, A P Klausner1
1Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Introduction:
AUA guidelines recommend periprocedural antibacterial prophylaxis for high risk patients undergoing in-office cystoscopy. We sought to determine if implementation of a simple quality improvement protocol could increase guideline compliance.
Methods:
As part of a quality improvement initiative, 4 simple changes were incorporated into our practice for in-office cystoscopy, including creation of a "yes/no" checklist to identify high risk patients, checklist review and electronic antibiotics order placed by urology provider, immediate nurse directed administration of single doses of the most common recommended antibiotics, and review of the checklist and antibiotic administration during the preprocedural time-out. We retrospectively compared antibiotic adherence in patients 3 months before and 3 months after implementation of the intervention. Data collected included age, gender, indication for procedure, type of procedure and high risk status.
Results:
A total of 307 patients were included in the study (157 before implementation and 150 after implementation of the protocol). In the pre-intervention group 120 patients (76.4%) were considered high risk and should have been administered antibiotic prophylaxis, although only 38 (31.7%) actually received it. In the post-intervention group 104 patients (69.3%) were considered high risk and should have been given antibiotic prophylaxis, and 84 (80.8%) actually received it. Overall, this quality improvement initiative resulted in a 49.1% increase in appropriate antibiotic administration (p <0.0001).
Conclusions:
Implementation of a simple 4-step quality improvement initiative resulted in a significant increase in the administration of appropriate antibiotics for in-office cystoscopy.
Insights
A quality improvement initiative significantly increased antibiotic prophylaxis adherence for high-risk patients undergoing in-office cystoscopy, improving patient safety and guideline compliance.
Area of Science:
- Urology
- Infectious Disease Prevention
- Quality Improvement in Healthcare
Background:
- AUA guidelines mandate antibiotic prophylaxis for high-risk patients during in-office cystoscopy.
- Compliance with these guidelines is crucial for preventing infections.
- Current adherence rates necessitate targeted interventions.
Purpose of the Study:
- To assess the impact of a quality improvement initiative on antibiotic prophylaxis adherence.
- To evaluate the effectiveness of a 4-step protocol in improving guideline compliance for in-office cystoscopy.
- To enhance patient safety through standardized antibiotic administration.
Main Methods:
- A retrospective study compared antibiotic adherence before and after implementing a 4-step quality improvement protocol.
- The protocol included a high-risk patient checklist, provider order entry, nurse-directed administration, and preprocedural time-out review.
- Data from 307 patients (157 pre-intervention, 150 post-intervention) were analyzed.
Main Results:
- Pre-intervention: 31.7% adherence among 120 high-risk patients.
- Post-intervention: 80.8% adherence among 104 high-risk patients.
- A 49.1% increase in appropriate antibiotic administration was observed (p < 0.0001).
Conclusions:
- A simple 4-step quality improvement initiative significantly improved antibiotic prophylaxis adherence for in-office cystoscopy.
- The protocol effectively increased the administration of appropriate antibiotics to high-risk patients.
- This initiative demonstrates a successful strategy for enhancing guideline compliance and patient safety.
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