Audit on the use of prophylactic parenteral antimicrobial agents and the use of co-amoxiclav and metronidazole.

UNLABELLED: Following the recommendations of a previous audit, specific objectives were chosen for reaudit. The aim was to measure the adherence to agreed protocols for the use of prophylactic antimicrobial agents; including the use of the once only part of the Kardex and to measure the adherence to protocols for the use of parenteral co-amoxiclav and metronidazole. The audit was conducted in the same hospital as the original study. Data was collected for one month on all patients receiving prophylactic antimicrobial agents, parenteral co-amoxiclav or metronidazole. A microbiologist assessed the compliance to the agreed written protocols, which had been distributed and explained to each resident. One hundred and eighty-eight patients received 226 antimicrobial courses (649 doses). Seventy-two per cent of courses were considered appropriate compared with 65% in 1993. The criteria for this audit only allowed one cephalosporin choice per directorate and accounted for the inappropriateness of choice to be 19% compared with 12% in 1993. This was confined to one directorate and an overall improvement of 79% would have been achieved if any cephalosporin could be chosen as 1993. Eighty-two per cent of doses were considered appropriate if written in the once only part of the Kardex or the anaesthetic sheet compared with 51% of those written in the general part. Only nine per cent of courses were too long compared with 16% in 1993. Fifty seven patients were given 125 days of co-amoxiclav, 94 days for treatment and 31 days for prophylaxis. Co-amoxiclav use overall was 33% less than 1993 with an improvement of appropriateness from 30% to 68%.

CONCLUSIONS

An overall improvement in the appropriateness of prophylactic antibiotic use was achieved by the implementation of agreed protocols. An automatic stopping system reduced the continuation of prophylaxis.