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 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 Variation in practice for preoperative antibiotic prophylaxis: a survey from an academic tertiary referral center in the United States

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nikhil Ailaney ◽  
Elizabeth Zielinski ◽  
Michelle Doll ◽  
Gonzalo M. Bearman ◽  
Stephen L. Kates ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Best Practice ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
The United States ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Anesthesia Providers ◽  
Preoperative Antibiotic Prophylaxis

Abstract Background Antibiotic surgical prophylaxis is a core strategy for 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. This study was designed to determine the individual perspectives of perioperative providers at an academic tertiary referral center regarding their knowledge of preoperative antibiotic choice, dosing, and timing. Methods A prospective survey was conducted amongst surgical and anesthesia team members involved in preoperative antibiotic decision making. The survey addressed ten key principles relating to preoperative antibiotic use, including antibiotic choice, timing and rate of infusion, and dosing. The survey was distributed among orthopaedic surgeons, residents, and anesthesia providers at their respective monthly service line meetings between August 2017 to June 2019. The data was stored and analyzed in a Microsoft Excel worksheet. Results A total of 73 providers completed the survey. Twenty-two (30 %) of the providers agreed and 47 (64 %) disagreed that both vancomycin and cefazolin are equally effective for antibiotic prophylaxis. As for antibiotic choice in patients with penicillin allergies, 37 (51 %) agreed with vancomycin, 21 (29 %) agreed with clindamycin, and 15 (21 %) disagreed with both alternatives. When providers were surveyed regarding the appropriateness of standard versus weight adjusted dosing, 67 (92 %) agreed that vancomycin should be weight adjusted and 63 (86 %) agreed that cefazolin should be weight adjusted. Conclusions There is no clear consensus amongst providers for which antibiotic to administer for antibiotic prophylaxis despite existing guidelines. Discrepancy also exists between orthopaedic surgery and anesthesia providers in regards to appropriate antibiotic choice for patients with reported penicillin allergies. Institutions should implement evidence-based protocols for preoperative antibiotic prophylaxis and continue to prospectively monitor compliance in order to identify any inconsistencies that could result in inappropriate antibiotic prophylaxis for patients.

scholarly journals Implementation of a Quality Improvement Strategy to Increase Outpatient Kidney Transplant Referrals

2020 ◽  
Author(s):  
Samira Farouk ◽  
Sarah Atallah ◽  
Kirk N Campbell ◽  
Joseph A Vassalotti ◽  
Jaime Uribarri
Keyword(s):  
Quality Improvement ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Outpatient Setting ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Important Barrier ◽  
Transplant Evaluation ◽  
End Stage ◽  
The Impact

Abstract Background: Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic. Methods: Over a 3 month period (July 1 - September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18 - 75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m 2 (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. Physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m 2 . Results: 54 unique patients with eGFR ≤ 20 ml/min/1.73 m 2 were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001). Conclusions: Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting Next steps include further study of the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.

Sign in / Sign up

Export Citation Format

Share Document