Medical committee enforcement of policy limiting postsurgical antibiotic use.

A hospital policy enforced by medical staff committees limiting prophylactic antibiotic use is described. The pharmacy department is authorized to discontinue prophylactic antibiotic orders at 72 hours postoperatively for patients in whom there is no sign of infection. Decentralized pharmacists screen antibiotic orders for formulary status and appropriateness. Forty-eight hours postoperatively, pharmacists evaluate patients for infection and document in each patient's chart that the antibiotic will be discontinued within 24 hours unless renewed by the physician. Pharmacists document situations in which a physician renews the antibiotic and no infection is present. Audits of antibiotic use are performed, and the quality assurance, medical credentialing, and surgery committees deal with noncompliant physicians. For 153 prophylactic antibiotic orders audited in January 1981 before the program was implemented, approximately 50% were discontinued within 72 hours. During the same period in January 1984 when the 72-hour policy had been in effect one year, this percentage had increased to 85%. Two individual surgeons and one group of surgeons (urologists) who never complied with the policy were referred in 1983 to the surgery committee. After consultation, the two surgeons changed their standing orders to comply with the policy, and the urologists were granted an exception that was to be reviewed annually. The support of the medical staff in ensuring physician compliance has been the key element in the success of this policy.