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Background and Aims This study assessed adherence to surgical antibiotic prophylaxis guidelines in nursing home residents undergoing orthopaedic implant surgery under spinal anaesthesia. Following the initial data collection, targeted interventions—such as staff education and clearer guideline dissemination—will be introduced to improve compliance.Methods Patients residing in nursing homes who underwent emergency hip surgery under spinal anaesthesia at Sligo University Hospital were identified Inclusion Criteria Nursing home residents who underwent emergency hip surgery at SUH between From July 2024 to December 2024 Exclusion Criteria: Patients with a documented allergy to antibiotics Data collection was conducted retrospectively using the patients’ anaesthetic records to determine the prophylactic antibiotics administered at the time of surgery.Results None of the patients received appropriate antibiotic prophylaxis based on their MRSA risk status: 7 patients received cefuroxime alone, despite being classified as high-risk for MRSA. 2 patients received both cefuroxime and teicoplaninConclusions Factors such as an aging population and advancements in neuraxial anaesthesia have contributed to an increase in the number of hip replacements among NHR. While improvements in anaesthetic and surgical techniques have reduced overall complication rates, periprosthetic joint infections (PJIs) remain a significant concern. This underscores the critical importance of appropriate antibiotic prophylaxis. This audit identified a substantial gap in adherence to antibiotic prophylaxis guidelines for NHR undergoing emergency hip surgery at SUH. Despite local protocols recommending the use of teicoplanin for patients with known or suspected MRSA colonisation, none of the patients received the appropriate prophylaxis. Potential contributing factors include a lack of awareness of existing guidelines and limited accessibility to clear, up-to-date guidance for clinical staff.