3331 A QUALITY ASSURANCE POLICY DECREASES INAPPROPRIATE USE OF PROPHYLACTIC ANTIBIOTICS FOR ENDOCARDITIS PRIOR TO GASTROINTESTINAL ENDOSCOPY.

Abstract

Objective: There are no universal standards for antibiotic prophylaxis before gastrointestinal endoscopy to prevent endocarditis. Recommendations have been issued by the AHA, the ASGE, the ACG and the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Diseases of the Young. Recognizing that antibiotics were prescribed inappropriately in our own unit, we developed a quality assurance (QA) policy in 1990. Methods: A survey identifying patients with potential indicators for antibiotic prophylaxis was included in the nursing assessment notes. Data were collected prospectively over 10 years (1990- 1999) to determine whether or not antibiotics were administered appropriately for approved indications. Results: Annual samples of consecutive patients totaling 3692 were assessed for indicators for and actual use of antibiotic prophylaxis. During the first three years 743 patients were reviewed, antibiotics were appropriately given in 32 (4.3%), inappropriately in 28 patients (3.8%) or appropriately withheld in 671 (90.3%). For the remaining 2949 patients during the following seven years, antibiotics were used appropriately in 7 (0.2%), were appropriately withheld in 2905 (98.5%), and unnecessarily administered in 32 (1.1%). Conclusions: Implementation of a policy to guide the administration of prophylactic antibiotics for endocarditis in gastrointestinal endoscopic procedures is effective in reducing unnecessary prescribing. This is cost effective, easily implemented and improves the quality of patient care.