Antibiotic prophylaxis in cesarean section: use of cost per case comparison to influence prescribing practices.
Results of a previously conducted DUE revealed that 91% of obstetric patients received antibiotic prophylaxis with cefoxitin despite the existence of obstetric department guidelines recommending the use of cefazolin. In the present DUE, antibiotic selection in C-section prophylaxis was reviewed and individual prescribers, both compliant and noncompliant with guidelines, were identified. Over a 2-month period, physicians who prescribed other than cefazolin for C-section prophylaxis were issued "Dear Doctor" letters, reminding them of existing guidelines. A significant change in prescribing patterns following this intervention was not demonstrated. A multidisciplinary approach was then undertaken. Prescribers were stratified by number of procedures, antibiotic requested, and antibiotic cost per case (average and median). Results were reviewed with Co-chiefs of Ob/Gyn. Letters to both compliant and noncompliant prescribers were issued. A grand rounds presentation describing the results of the DUE was also given. A follow-up review showed that the conversion to cefazolin prophylaxis reached 80%, with accompanied extrapolated yearly cost avoidance of nearly $5,500.
Sinai Samaritan Medical Center, Milwaukee, WI 53233.
B
B
Weir
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching; D006801:Humans; D017410:Practice Guidelines as Topic; D011292:Premedication; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014922:Wisconsin