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