Abstract：
BACKGROUND: 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.
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.
摘要：
背景：AUA指南建议对行膀胱镜检查的高危患者进行围手术期抗菌预防。我们试图确定实施简单的质量改进方案是否可以提高指南的合规性。
方法：作为质量改进计划的一部分，4个简单的变化被纳入我们的办公室膀胱镜检查的实践，包括创建“是/否”检查表以识别高风险患者，泌尿科提供者下的清单审查和电子抗生素订单，立即护士指导单剂量最常见的推荐抗生素给药，以及在程序前超时期间审查检查表和抗生素的使用。我们回顾性比较了干预前3个月和实施后3个月患者的抗生素依从性。收集的数据包括年龄，性别,程序指示,程序类型和高风险状态。
结果：共307例患者纳入研究（实施前157例，实施后150例）。在干预前组中，120名患者（76.4%）被认为是高风险的，应该给予抗生素预防，虽然只有38人(31.7%)实际收到了。在干预后组中，104名患者（69.3％）被认为是高风险的，应该给予抗生素预防，84人(80.8%)实际收到了。总的来说,这项质量改进举措使适当的抗生素给药增加了49.1%(p<0.0001).
结论：实施简单的4步质量改进计划导致在办公室膀胱镜检查中使用适当抗生素的显着增加。
方法：作为质量改进计划的一部分，4个简单的变化被纳入我们的办公室膀胱镜检查的实践，包括创建“是/否”检查表以识别高风险患者，泌尿科提供者下的清单审查和电子抗生素订单，立即护士指导单剂量最常见的推荐抗生素给药，以及在程序前超时期间审查检查表和抗生素的使用。我们回顾性比较了干预前3个月和实施后3个月患者的抗生素依从性。收集的数据包括年龄，性别,程序指示,程序类型和高风险状态。
结果：共307例患者纳入研究（实施前157例，实施后150例）。在干预前组中，120名患者（76.4%）被认为是高风险的，应该给予抗生素预防，虽然只有38人(31.7%)实际收到了。在干预后组中，104名患者（69.3％）被认为是高风险的，应该给予抗生素预防，84人(80.8%)实际收到了。总的来说,这项质量改进举措使适当的抗生素给药增加了49.1%(p<0.0001).
结论：实施简单的4步质量改进计划导致在办公室膀胱镜检查中使用适当抗生素的显着增加。
