Adherence to AUA Guidelines for Periprocedural Antibiotics for In-Office Cystoscopy after Implementation of a Simple Quality Improvement Protocol.

Abstract

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. 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. 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). Implementation of a simple 4-step quality improvement initiative resulted in a significant increase in the administration of appropriate antibiotics for in-office cystoscopy.