scholarly journals 1096. Reducing Unnecessary Postoperative Antibiotic Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S389-S390
Author(s):  
Talene A Metjian ◽  
Jeffrey Gerber ◽  
Adam Watson ◽  
Caroline Burlingame ◽  
Heuer Gregory ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibiotic Prophylaxis ◽  
Adverse Drug Events ◽  
Tethered Cord ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Quality Improvement Initiative ◽  
National Guidelines ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP). Methods We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression. Results Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36). Conclusion A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates. Disclosures All authors: No reported disclosures.

scholarly journals Improving intraoperative administration of surgical antimicrobial prophylaxis: a quality improvement report

2020 ◽  
Vol 9 (3) ◽  
pp. e001042
Author(s):  
Victoria Haney ◽  
Stephan Maman ◽  
Jansie Prozesky ◽  
Dmitri Bezinover ◽  
Kunal Karamchandani
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Prophylaxis ◽  
Surgical Care ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Antibiotic Administration ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Surgical Antimicrobial Prophylaxis ◽  
Care Improvement

Despite widespread adoption of the Surgical Care Improvement Programme, the incidence of surgical site infections (SSIs) remains high. It is possible that lapses in appropriate administration of antimicrobial prophylaxis may play a role. We noted significant discordance with national guidelines with regards to intraoperative antibiotic administration at our institution, leading to implementation of a quality improvement initiative using multidisciplinary education and reminder-based interventions to improve prescribing practices and increase compliance with national guidelines. We observed a significant improvement in adherence to all aspects of antibiotic administration guidelines as a result of such interventions. Targeted multidisciplinary interventions may help improve prescribing practices of surgical antimicrobial prophylaxis and provide an opportunity to potentially decrease the burden of SSI and the related morbidity and mortality.

scholarly journals Understanding of Optimum Antibiotic Prophylaxis is Inconsistent Among Orthopaedic Surgery and Anesthesia Teams

2021 ◽  
Author(s):  
Nikhil Ailaney ◽  
Elizabeth Zielinski ◽  
Michelle Doll ◽  
Gonzalo M. Bearman ◽  
Stephen L. Kates ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibiotic Prophylaxis ◽  
Orthopaedic Surgery ◽  
Best Practice ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Educational Training ◽  
Improvement Strategy ◽  
Chi Square ◽  
Quality Improvement Strategy

Abstract Background Antibiotic surgical prophylaxis is a core strategy for the prevention of surgical site infections (SSI). Despite best practice guidelines and known efficacy of antibiotic prophylaxis in decreasing SSI risk, there is often wide variation in its use. We performed this study to assess antibiotic prophylaxis perspectives of orthopaedic surgery and anesthesiology teams at our institution regarding preoperative antibiotic choice, dosing, and timing.Methods An IRB approved questionnaire was distributed amongst orthopaedic surgery and anesthesia team members involved in preoperative antibiotic decision making from August 2017 to June 2019. The questionnaire addressed ten key practices relating to preoperative antibiotic use, including antibiotic choice, timing, rate of infusion, and dosing. Provider and service type responses were also compared using Chi-square tests. Results Two nurse practitioner (NP), 22 resident, and 23 attending orthopaedic surgery providers completed the survey. Twelve nurse anesthetist (CRNA), 6 resident, and 8 attending anesthesiology providers completed the survey. Only 30% of all providers agreed that both vancomycin and cefazolin are equally effective for the purpose of antibiotic prophylaxis. As for the antibiotic choice in patients with penicillin allergies, 50% agreed with vancomycin, 28% agreed with clindamycin, and 22% disagreed with both alternatives. Furthermore, resident physicians more frequently agreed with vancomycin (71%) compared to NPs (29%), and attendings physicians (35%) (p=0.014). A majority of providers agreed with the necessity of weight-based dosing and timely infusion of vancomycin.Conclusions There is no clear consensus amongst providers for which antibiotic to administer for antibiotic prophylaxis despite existing guidelines. Discrepancy exists between orthopaedic and anesthesia providers for which antibiotic to administer in patients with penicillin allergies. Institutions should evaluate antibiotic prophylaxis perspectives amongst their perioperative staff in order to identify any inconsistencies that could result in inappropriate antibiotic prophylaxis for patients. A multifactorial quality improvement strategy that includes development of a protocol, displaying prophylaxis guidelines in perioperative areas, educational training, a preoperative checklist, and optimizing the electronic medical record should be implemented to standardize prophylaxis practices. It is also integral to involve both the orthopaedic and the anesthesia staff in the quality improvement process otherwise discrepancies may continue to persist.

scholarly journals Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study

2021 ◽  
Vol 10 (3) ◽  
pp. e001089
Author(s):  
Hoang Thi Tran ◽  
John Charles Scott Murray ◽  
Howard Lawrence Sobel ◽  
Priya Mannava ◽  
Le Thi Huynh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Relative Risk ◽  
Caesarean Section ◽  
Environmental Changes ◽  
Newborn Care ◽  
Adverse Outcomes ◽  
National Guidelines ◽  
Post Intervention ◽  
Essential Newborn Care ◽  
Newborn Outcomes

BackgroundTo improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.MethodsMaternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.FindingsA total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).ConclusionThe EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.

66 - Impact of Postoperative Neurosurgery Order Sets on Glycemic Control and Surgical Site Infections: A Quality-Improvement Initiative

2019 ◽  
Vol 43 (7) ◽  
pp. S26
Author(s):  
Dena Sommer ◽  
Barbara Mcarthur ◽  
Mahsa Sadeghi ◽  
Mary Rozmanc ◽  
Avery Nathens ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Glycemic Control ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Order Sets

scholarly journals Project Console: a quality improvement initiative for neonatal abstinence syndrome in a children’s hospital level IV neonatal intensive care unit

2021 ◽  
Vol 10 (2) ◽  
pp. e001079
Author(s):  
Kathryn L Ponder ◽  
Charles Egesdal ◽  
Joanne Kuller ◽  
Priscilla Joe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Abstinence Syndrome ◽  
Quality Improvement Initiative ◽  
Abstinence Syndrome ◽  
Post Intervention ◽  
High Acuity

ObjectiveTo improve care for infants with neonatal abstinence syndrome.DesignInfants with a gestational age of ≥35 weeks with prenatal opioid exposure were eligible for our quality improvement initiative. Interventions in our Plan–Do–Study–Act cycles included physician consensus, re-emphasis on non-pharmacological treatment, the Eat Sleep Console method to measure functional impairment, morphine as needed, clonidine and alternative soothing methods for parental unavailability (volunteer cuddlers and automated sleeper beds). Pre-intervention and post-intervention outcomes were compared.ResultsLength of stay decreased from 31.8 to 10.5 days (p<0.0001) without an increase in readmissions. Composite pharmacotherapy exposure days decreased from 28.7 to 5.5 (p<0.0001). This included reductions in both morphine exposure days (p<0.0001) and clonidine exposure days (p=0.01). Fewer infants required pharmacotherapy (p=0.02).ConclusionsOur study demonstrates how a comprehensive initiative can improve care for infants with neonatal abstinence syndrome in an open-bay or a high-acuity neonatal intensive care unit when rooming-in is not available or other comorbidities are present.

scholarly journals 43. Impact of a Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Antibiotic Prophylaxis Selection in Surgery in a Hospital without Restrictions on Antibiotics Prescription in Costa Rica

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
José P Díaz-Madriz ◽  
Esteban Zavaleta-Monestel ◽  
Jorge A Villalobos-Madriz ◽  
Alison V Meléndez-Alfaro ◽  
Priscilla Castrillo-Portillo ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Antimicrobial Stewardship ◽  
Bacterial Resistance ◽  
Positive Impact ◽  
Surgical Site Infections ◽  
Antimicrobial Stewardship Program ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Impact ◽  
Selection Of

Abstract Background In a private hospital without restrictions on antibiotic prescription, the success of an Antimicrobial Stewardship Program (ASP) depends mainly on prospective feedback and education. Previously, the ASP of this hospital (PROA-HCB) managed to achieve a positive impact on the antibiotic prophylaxis in cesarean delivery. The purpose of this study is to characterize the impact after implementing the PROA-HCB on the optimal prophylaxis selection of all the procedures included in the clinical guideline for surgical antibiotic prophylaxis in adult patients. Methods A retrospective observational study that compares the selection, duration, antibiotic consumption, bacterial resistance profiles and patient’s safety outcomes regarding antibiotic use for all surgical prophylaxis prescription over six months for the periods before (pre-ASP) and after a five-year intervention of PROA-HCB (post-ASP). Results After a five-year intervention, the percentage of optimal selection of antibiotic prophylaxis in Surgery was 21.0% (N=1598) in the pre-ASP period and 80.0% (N=841) in the post-ASP period (59% absolute improvement, p &lt; 0.001). Percentage of optimal duration was 69,1% (N=1598) in the pre-ASP period and 78.0% (N=841) in the post-ASP period (8.9% absolute improvement, p &lt; 0.001). Mean ceftriaxone utilization was 217.7 defined daily doses (DDD) per 1,000 patient days DDD for the pre-ASP period and 139.8 DDD per 1,000 patient days for the ASP period (35.8% decrease; p = 0.019). Mean cefazolin utilization was 14.9 DDD per 1,000 patient days for the pre-ASP period and 153.3 DDD per 1,000 patient days for the ASP period (928.6% increase; p = 0.021). Regarding percentage of bacterial resistance, there was detected an improvement in some isolates like Escherichia coli with a decrease of ESBL detection (11% decrease; p = 0.007). In addition, no serious adverse reactions or an increase in surgical site infections were detected after the intervention. Conclusion The implementation of an ASP in the surgical ward showed an overall positive impact on selection and duration of antibiotic prophylaxis. Furthermore, this intervention could have had a positive impact on antimicrobial resistance and at the same time had no negative effects on the patients. Disclosures All Authors: No reported disclosures

scholarly journals Use of video education in post-operative patient counselling: A quality improvement initiative

2021 ◽  
Vol 15 (12) ◽  
Author(s):  
Luke D.E. Witherspoon ◽  
Ailsa M.L. Gan ◽  
Rodney H. Breau ◽  
Ginette Saumure ◽  
Jacqueline Shea ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Discharge Rate ◽  
Intervention Group ◽  
Quality Improvement Initiative ◽  
Discharge Process ◽  
Post Intervention ◽  
Data Repositories ◽  
Patient Counselling ◽  
Video Education

Introduction: This quality improvement study examined if a video-based resource could reduce delayed discharges after robotic prostatectomy while maintaining high levels of patient satisfaction. Methods: From April 2018 to February 2020, all patients undergoing robotic-assisted radical prostatectomy (RARP) were asked to complete an anonymous survey evaluating their perioperative experience. The quality improvement (QI) intervention started in March 2019 with a series of six educational videos being shown to all patients. The videos were used to supplement postoperative instruction. The discharge times of all patients were obtained from The Ottawa Hospital Data Repositories. A run chart analysis was used to detect change in discharge time (outcome measure). Patient satisfaction (balancing measure) was analyzed using Chi-squared analysis and descriptive statistics. Results: A total of 425 robotic prostatectomies (199 pre-intervention, 226 post-intervention) were available. Analysis of the run chart revealed non-random change favoring earlier discharge in the intervention group (p<0.05), with a pre-intervention late discharge rate of 64% and a post-intervention late discharge rate of 55%. A total of 140 surveys (59 pre-intervention, 81 post-intervention) assessing patient satisfaction were completed, corresponding with a response rate of 29.6% and 35.8%, respectively. Median score on a 10-point scale for overall satisfaction was equal between the intervention and non-intervention groups (9 [interquartile range (IQR 8–10) vs. 10 [IQR 8-10], p=0.92). Conclusions: Patient satisfaction with care and education was high for all patients and was not negatively impacted by this intervention. Video education tools may be one method to help improve the discharge process following RARP.

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