Implementation and Evaluation of a Preprinted Perioperative Antimicrobial Prophylaxis Order Form in a Teaching Hospital

OBJECTIVE: To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis.DESIGN: A pre- and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures.SETTING: A 420-bed teaching hospital in the Hamilton-Wentworth region.PATIENTS: A three-month survey of 901 consecutive patients followed by a two-month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures.INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation.MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre- and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated.RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user-friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis.CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.

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Improvement in Prescribing Habits and Economic Outcomes Associated With the Introduction of a Standardized Approach for Surgical Antimicrobial Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/587811 ◽

2008 ◽

Vol 29 (5) ◽

pp. 457-461 ◽

Cited By ~ 15

Author(s):

Elizabeth D. Hermsen ◽

Sara Smith Shull ◽

Susan E. Puumala ◽

Mark E. Rupp

Keyword(s):

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Economic Outcomes ◽

Surgical Prophylaxis ◽

Prescribing Habits ◽

Order Form ◽

Quasi Experimental ◽

Antibiotic Duration ◽

Surgical Antimicrobial Prophylaxis ◽

The Impact

A quasi-experimental before-after study was conducted to determine the impact on prescribing habits and economic outcomes of an intervention that required use of an order form for surgical antimicrobial prophylaxis. Implementation of this intervention improved compliance with guidelines for prevention of surgical site infections, particularly with respect to choice of antibiotic, duration of use, and dosage, and resulted in decreased cost of surgical prophylaxis.

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Assessment of rational use of antibiotics in surgical prophylaxis and post- operative cases at district hospital Gulbarga

International Surgery Journal ◽

10.18203/2349-2902.isj20170038 ◽

2017 ◽

Vol 4 (2) ◽

pp. 555

Author(s):

Zaheeruddin Ather ◽

N. Lingaraju ◽

Santosh Lakshman ◽

S. S. Harsoor

Keyword(s):

Clinical Practice ◽

Antibiotic Prophylaxis ◽

Surgical Procedures ◽

District Hospital ◽

Antimicrobial Prophylaxis ◽

Wound Infections ◽

Surgical Prophylaxis ◽

American Society ◽

A Prospective Study ◽

Rational Use Of Antibiotics

Background: Postoperative wound infections are the major cause of morbidity in surgical patients. The use of pre and peri-operative antibiotics, with sound and appropriate principles of prophylaxis are applied can result in a reduced risk of postoperative infection. Although the principles of antimicrobial prophylaxis for surgical procedures have been well defined for many years, inappropriate and excessive use of antimicrobials for this purpose remains widespread.Methods: This was a prospective study conducted on the inpatients undergoing surgical procedures. ASHP (American Society of Health System Pharmacists) and SIGN (Scottish Intercollegiate Guidelines Network) guidelines were used as the standard guideline.Results: Of the total 150 procedures reviewed, 130 procedures were entered in the analysis. Of these procedures, the rate of totally compliant prescriptions was 28.46%. Totally in 93 (71.53%) patients, the antibiotic prophylaxis was found to be inappropriate. In 36 (27.70%) patients, indication for antibiotic prophylaxis was not proper and in total 38 (44.19%) patients, where antibiotic prophylaxis was justified and given, proper antimicrobial agent was not used.Conclusions: Instead of existence of the written guidelines for antimicrobial surgical prophylaxis there are significant deviations from the recommendations in current clinical practice. Adherence of antibiotic prophylaxis to these guidelines is needed to be evaluated routinely in clinical practice.

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Controversies in Perioperative Antimicrobial Prophylaxis

Anesthesiology ◽

10.1097/aln.0000000000003075 ◽

2020 ◽

Vol 132 (3) ◽

pp. 586-597 ◽

Cited By ~ 3

Author(s):

Brooke K. Decker ◽

Alexander Nagrebetsky ◽

Pamela A. Lipsett ◽

Jeanine P. Wiener-Kronish ◽

Naomi P. O’Grady

Keyword(s):

Antibiotic Prophylaxis ◽

Expert Opinion ◽

Surgical Procedures ◽

Clinical Guidelines ◽

Antimicrobial Prophylaxis ◽

Perioperative Prophylaxis ◽

Perioperative Antimicrobial Prophylaxis

Abstract Although clinical guidelines for antibiotic prophylaxis across a wide array of surgical procedures have been proposed by multidisciplinary groups of physicians and pharmacists, clinicians often deviate from recommendations. This is particularly true when recommendations are based on weak data or expert opinion. The goal of this review is to highlight certain common but controversial topics in perioperative prophylaxis and to focus on the data that does exist for the recommendations being made.

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Surveillance of Antimicrobial Prophylaxis for Surgical Procedures

Infection Control and Hospital Epidemiology ◽

10.1086/501680 ◽

1999 ◽

Vol 20 (9) ◽

pp. 610-613 ◽

Cited By ~ 43

Author(s):

Victor Vaisbrud ◽

David Raveh ◽

Yechiel Schlesinger ◽

Amos M. Yinnon

Keyword(s):

Infection Control ◽

Surgical Procedures ◽

Antimicrobial Prophylaxis ◽

Female Gender ◽

Routine Activity ◽

Infection Rates ◽

Surgical Prophylaxis ◽

Appropriate Care ◽

Clean Contaminated ◽

Recommended Guidelines

AbstractObjective:To assess the practice of antimicrobial prophylaxis for surgical procedures in eight surgical departments in a 550-bed teaching hospital.Methods:A list of all major procedures performed in our hospital, with recommendations for prophylaxis based upon the literature, has been distributed since 1993 and is updated periodically. The practice of surgical prophylaxis between January 1 and March 31,1996, was examined by assessing four variables: (1) Did the particular procedure justify prophylaxis, and was it provided? (2) Was timing optimal, ie, within 1 hour prior to surgery? (3) Was the appropriate antimicrobial selected? (4) Was duration optimal, ie, ≤24 hours?Results:During the study period, 2,117 operations were performed, of which 1,631 (77%) were reviewed. Sixty-six percent were clean surgery, 28% clean-contaminated, and 6% contaminated; 72% of procedures were elective, 28% emergencies. Of 1,631 operations requiring prophylaxis, 1,142 (70%) received it, 489 (30%) did not. Of 1,631 patients, 1,392 (85%) received appropriate care: 929 (67%) appropriately received prophylaxis, and 463 (33%) appropriately did not receive prophylaxis. Of 955 patients who received prophylaxis, 26 (3%) did so inappropriately. Of 1,142 patients who should have received prophylaxis, 213 (19%) did not receive it. Female gender, clean surgery, elective operations, and infrequently performed procedures were all significant indicators of inappropriately withheld prophylaxis (P<.001). In addition, the rate of appropriately provided prophylaxis varied between departments from 71% to 97% (P<.001). Assessment of the 929 procedures for which prophylaxis was justified and given revealed that 100% of patients received it on time, the choice of antimicrobial was appropriate in 95% of cases, and duration was ≤24 hours in 91%.Conclusions:Audits of surgical prophylaxis are expected to detect different errors in different institutions. Conducting audits of surgical prophylaxis probably should be part of the routine activity of infection control teams. Feeding the information back to surgeons could improve adherence to recommended guidelines and might contribute to reduced wound infection rates.

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Utilization of neurosurgical perioperative antimicrobial prophylaxis in a Chinese teaching hospital

International Journal of Clinical Pharmacy ◽

10.1007/s11096-021-01233-2 ◽

2021 ◽

Author(s):

Weiwei Zhang ◽

Huijie Meng ◽

Chientai Mao ◽

Yongfang Hu

Keyword(s):

Teaching Hospital ◽

Antimicrobial Prophylaxis ◽

Chinese Teaching ◽

Perioperative Antimicrobial Prophylaxis

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162. Assessment of Beta-lactam Allergies as Rationale for Receipt of Vancomycin for Surgical Prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.207 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S90-S90

Author(s):

Kendall J Tucker ◽

YoungYoon Ham ◽

Haley K Holmer ◽

Caitlin M McCracken ◽

Ellie Sukerman ◽

...

Keyword(s):

Antimicrobial Prophylaxis ◽

Skin Testing ◽

Cross Reactivity ◽

Penicillin Allergy ◽

Beta Lactam ◽

First Line ◽

Surgical Prophylaxis ◽

Inappropriate Use ◽

Oral Amoxicillin ◽

Ige Mediated

Abstract Background Beta-lactam (BL) antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between classes of BLs, patients with allergies commonly receive vancomycin as an alternative to avoid allergic reaction. The objective of this study was to identify potentially inappropriate use of vancomycin surgical prophylaxis among patients with reported BL allergies. Methods Adult patients (≥18 years) receiving vancomycin for surgical prophylaxis with a reported penicillin and/or cephalosporin allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Surgery type and allergy history were extracted from the electronic medical record. Per our institution’s penicillin-testing protocol, patients with IgE-mediated reactions < 10 years ago were eligible for penicillin skin testing (PST), mild reactions or IgE-mediated reaction > 10 years ago were eligible for direct oral amoxicillin challenge, and severe non-IgE mediated allergies were ineligible for penicillin allergy evaluation or BL prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported BL allergy and were included in the analysis (155 with penicillin allergy alone; 21 with cephalosporin allergy; 20 with both cephalosporin and penicillin allergy). Approximately 40% of surgeries were orthopedic. Six patients were ineligible for BL prophylaxis. Per institutional protocol, 73 of 155 patients (48%) may have qualified for PST; 81 of 155 (52%) patients may have received a direct oral amoxicillin challenge. Only 3 of 22 patients with history of methicillin-resistant Staphylococcus aureus appropriately received additional prophylaxis with vancomycin and a BL. Conclusion Patients with BL allergies often qualify for receipt of a first-line BL antibiotic. An opportunity exists for improved BL allergy assessment as an antimicrobial stewardship intervention. Future studies should evaluate outcomes associated with BL allergy evaluation and delabeling in patients receiving surgical prophylaxis. Disclosures All Authors: No reported disclosures

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