An audit of prophylactic antibiotic prescribing patterns in orthopaedic practice

As part of the regular monthly audit of orthopaedic practice in Sheffield the prescribing patterns of orthopaedic surgeons were evaluated by questionnaire. Staff questioned were consultant orthopaedic surgeons and surgeons in training. The questionnaire depicted two areas of prophylactic antibiotic use: prescribing patterns in primary total hip replacement and in a number of procedures for closed fractures. The responses were anonymous. The results showed a range of treatment regimes were being used, although everyone prescribed an appropriate antibiotic at the time of surgery in primary joint replacement. The number of postoperative doses varied from none to treatment for 1 week. 78% continue intravenous therapy for 24 h. Prescribing patterns were not so clearly defined in surgery for closed fractures. 13% prescribe no prophylaxis in hip fracture fixation while 16% would prescribe intravenous therapy for 24 h after closed Kirshner wiring of a metacarpal fracture. The discussion of the findings has enabled the introduction of guidelines which should lead to optimal patient care and use of resources.