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Preventing Surgical Infections Preventing Surgical Infections Through Effective Perioperative Through Effective Perioperative
Antibiotic AdministrationAntibiotic Administration
Preventing Surgical Infections Preventing Surgical Infections Through Effective Perioperative Through Effective Perioperative
Antibiotic AdministrationAntibiotic Administration
Project Team Members:AnesthesiaInfectious DiseasePharmacySurgical ServicesCenter for Clinical Effectiveness
Opportunity StatementOpportunity StatementOpportunity StatementOpportunity Statement
Current evidence and expert consensus call for administration of prophylactic antibiotic dosing within 60 minutes of surgical incision.
LUHS chart review showed that only 73% of cases received the initial antibiotic within 60 minutes of incision
Goal: To ensure that perioperative antibiotics are administered appropriately for all LUHS surgical patients
National Focus (CMS/CDC) on National Focus (CMS/CDC) on Reduction of Surgical InfectionsReduction of Surgical InfectionsNational Focus (CMS/CDC) on National Focus (CMS/CDC) on Reduction of Surgical InfectionsReduction of Surgical Infections
Recommended Surgeries:CABG, Other Cardiac, Hip & Knee Arthroplasty, Colon Abdominal & Vaginal hysterectomy, Vascular
Performance Measures:1. Prophylactic antibiotics within 1 hour before surgical
incision (current LUHS measure)
2. Antibiotics consistent with current published recommendations (added LUHS measure –11/02)
3. Antibiotics are discontinued within 24 hours after the end of surgery (not measured at this time)
Most Likely CausesMost Likely CausesMost Likely CausesMost Likely Causes
Accountability for process is not clearly defined (Surgeon, Anesthesia, Nurse)
Variation in physician ordering practices
Order for antibiotic not written prior to surgery
Variable practices of anesthesiologist’s drug administration and documentation
Solutions ImplementedSolutions ImplementedSolutions ImplementedSolutions Implemented
FY02 Activities
Project Team assembled
Literature review & data collection
Guideline & reference tools developed
Un-restriction of Vancomycin
Standardized documentation
Education of all providers
FY03 ActivitiesGuidelines on the EMR
Anesthesia record revised
Standard order sheets
Anesthesia department education
Shared results with departments
Antibiotic administration prior Antibiotic administration prior to surgery has improvedto surgery has improved
Antibiotic administration prior Antibiotic administration prior to surgery has improvedto surgery has improved
Antibiotics Given Within 60 Minutes Prior To Incision
73
9894
9291
76
95
83
55
60
65
70
75
80
85
90
95
100
Jul-Oct-00N=545
Nov-01 N=60 Feb-02 N=60 Apr-02 N=60 May-02 N=60 July-02 N=80 Sep-02 N=60 Nov-02 N=70
Chart Review Time
Per
cen
t o
f P
atie
nts
Project Started
Confidential: For QI purposes only
Antibiotic appropriateness Antibiotic appropriateness varies by servicevaries by service
Antibiotic appropriateness Antibiotic appropriateness varies by servicevaries by service
Use of Appropriate AntibioticNovember 2002
30%
60%
70%
90%
100% 100%
0%10%20%30%40%50%60%70%80%90%
100%
Other C
V
CABG
Vascu
lar
Hyster
ecto
my
Colon
Hip &
Knee
Surgery Type
Pe
rce
nt
Co
mp
lian
ce
Next StepsNext StepsNext StepsNext Steps
Education of physicians regarding use of the correct antibiotic
Implement standard order sheet in SAC
Share results with individual departments
Measure use of antibiotics post-operatively
Review existing and new surgical order sets to ensure appropriate antibiotic prophylaxis
Recommended