Abstract :
ISSUE: Surgical infection prevention corporate requirement to monitor the use of pre-op antibiotics for vascular, hip/knee arthroplasty, colon, and hysterectomy. Three indicators: A) prophylactic antibiotic within 1 hour prior to surgical incision, B) correct prophylactic antibiotic selection, C) prophylactic antibiotics d/c within 24 hours post surgery end time.
PROJECT: Initial quarterly review during October-December 2003, obtained through retrospective chart review. Compliance: A) 60%, B) 87%, C) 75%. Department chairs requested to review criterion with staff. No improvement seen in next two quarters. Task force formed by medical director with authority given to anesthesia chief. After unsuccessful staff education meetings, the task force decided to link pre-op antibiotic administration to the mandatory “time out” in the operating room (OR) immediately prior to surgery. Anesthesiologist asks surgeon what antibiotic to administer and administers prior to incision. Anesthesia record modified to note antibiotics given or reason why not given. Meetings held with all surgeons to explain new process. Appropriate antibiotics listed by procedure in each OR. Computerized pre-op antibiotic ordering modified not to allow re-ordering of pre-ops to extend past 24 hours. Surgeons found not to be compliant are reported to medical director.
RESULTS: Board report prepared quarterly. No improvement until anesthesia took responsibility. July-September 2004: A) 100%, B) 100%, C) 97%. We continue to be compliant.
LESSONS LEARNED: Verbal and written education was not enough to change surgical practices; individual accountability of the surgeon was also necessary. Teamwork and brainstorming were keys to developing ideas. The coordination by one person having the authority and responsibility was the most important factor in attaining compliance among the various surgical disciplines.
