6 - Implementation of a Multidisciplinary Prophylactic Antibiotic Redosing Protocol in the Surgical Services Department: A Quality Improvement Project

Description: Backgorund/Problem:
While research and guidelines demonstrate the efficacy of prophylactic antimicrobial therapy and the importance of redosing antibiotics during long operative cases, surgical site infections persist and cause financial havoc for health care organizations. Nonadherence to prophylactic antimicrobial guidelines among surgical staff at a level 1 trauma center, remains a barrier to reducing SSIs as identified by infection prevention data. Due to the lack of a prophylactic antibiotic administration and re-dosing protocol within the surgical services department, adult surgical patients undergoing invasive surgical procedures are potentially at higher risk for developing SSIs, and may suffer negative surgical outcomes such as prolonged hospital stay, increased recovery time, and significant morbidity and mortality.

Purpose
The purpose of this quality improvement project was to determine the impact of a prophylactic antibiotic re-dosing protocol for adult patients undergoing invasive surgical intervention. The project expanded the use of evidence-based research to a subgroup of patients undergoing surgical procedures at an academic level 1 trauma center in Nebraska. The evaluation of this project will be measured by the following outcomes (a) incidence rates of surgical site infections for patients undergoing surgery, pre, and post-intervention, and (b) adherence to SSI prevention protocols among the surgical services team as measured by the prophylactic antimicrobial audit tool.

Methods/

Design:
The DNP project was based on a quality improvement project theoretical framework with the implementation of a practice intervention design. This project implemented a multidisciplinary approach to surgical prophylaxis antimicrobial administration and redosing in a surgical services department. The antibiotic audit tool tracked surgical antimicrobial prophylaxis administration and re-dosing information and facilitated the evaluation of adherence among the perioperative staff. This project’s patient population included a convenience sample of 326 adult patients, age 19 years or older, who have had a pre-operative physical and had a planned surgical intervention performed of various surgical specialties. Data was collected and analyzed over eight weeks.

Results:
Out of the 326 cases analyzed, in 260 (79.8%) cases, surgical staff completed the antibiotic audit form appropriately. When examining proper administration of prophylactic antibiotics within the appropriate time before incision, all patients who required antimicrobial prophylaxis, (286 patients) received proper administration. Furthermore, 58 cases out of the 326 cases required redosing of antibiotics, which were redosed appropriately 100% of the time. Surgical site infection rate data results from the implementation period are still pending.