“Have we got it right”? Surgical An6bio6c Prophylaxis M. Leadsom Infec/on Preven/on Prac//oner M. Griesel Ward Clinical Pharmacist M. Barnes Theatre Matron
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
“Have we got it right”? Surgical An6bio6c Prophylaxis
M. Leadsom Infec/on Preven/on Prac//oner M. Griesel Ward Clinical Pharmacist M. Barnes Theatre Matron
Context
This quality improvement project was conducted in the main theatres and was led by • the infec/on preven/on prac//oner • the ward pharmacist In collabora/on with • key members of staff in theatre • a senior anaesthe/st
Support & Collaboration
• Senior Hospital Management • An/bio/c Stewardship CommiIee • Microbiologists • Physicians Advisory Board • Theatre Forum (chair held by senior surgeon) • Infec/on Preven/on CommiIee • Individual surgeons & anaesthe/sts
Problem
There was: • no previous research into compliance. • no evidence to prove pa/ents were receiving prophylac/c an/bio/cs in line with best prac/ce.
• no local guidelines available for reference.
Obstacles to measurement
• incision /me oOen not recorded in peri-‐opera/ve document (no prompt reques/ng staff to do so).
• an/bio/c dose and /me of administra/on not always recorded.
Our Mission
• the aim of the interven/on is to ensure each and every pa/ent receives the correct an/bio/c at the correct dose at the right /me and for the right dura/on of /me.
“ Perfect Prophylaxis”
• and to ensure this is integrated into the surgical site bundle, whilst addressing all aspects of an/bio/c stewardship.
Our Vision
Our mission is aligned with Netcare’s triple aim goal in providing
Best pa2ent experience & outcome in the
most cost effec2ve way
Interventions
• All peri-‐opera/ve documents are ink-‐stamped with incision /me on arrival in theatre receiving.
• There is a cuUng /me prompt on the theatre board. • Designated person calls out the cuUng /me for logging. • Ensure /me and dose of an/bio/c administered is clearly
documented. • Prescrip/on charts are followed up to measure if an/bio/c
stopped at 24 hours (or sooner). • Local guidelines made available to all. • Aspects of non-‐compliance addressed with relevant surgical
team.
Change Strategy
Ins/tute of Healthcare Improvement • “Collabora/ve Model” 2003 • “Going Lean in Healthcare” 2005
A Series of PDSA Cycles (learning, action.... PDSA)
• .
Quantifying Data
• Data was collected from the case notes of major (adult )surgical cases, to measure compliance to the four aspects of surgical an/bio/c prophylaxis & distributed to each discipline so areas of non-‐compliance could be addressed.
Percentage of Peri-‐opera/ve documents with NO incision /me recorded (9 April 2013 – 31 July 2013).
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
Week 1
Week 3
Week 5
Week 7
Week 9
Week 11
Week 13
Week 15
Week 17
Week 19
Week 21
Week 23
Week 25
Week 27
Week 29
Week 31
Week 33
Week 35
Week 37
Week 39
Week 41
Week 43
Week 45
Week 47
Week 49
Week 51
Week 53
Week 55
% peri-‐o
pera6v
e do
cumen
ts with
NO incision
6me
Weekly Run Chart: % of Peri-‐Opera6ve documents with NO incision 6me
% of peri-‐opera/ve documents with NO incision /me
Median: % peri-‐opera/ve documents with NO incision /me
GOAL: 10% of peri-‐opera/ve documents with NO incision /me.
Median: 39%
Start date: 9/4/2013
Week 10: STAMP
Improvement made
Week 6: Team leader involvement
Week 14:Posters in theatre: “Timing of
an/bio/c”
Percentage of an/bio/cs administered < 60min before incision
(4 April – 31 July 2013).
0,0
20,0
40,0
60,0
80,0
100,0
120,0
Week 1
Week 3
Week 5
Week 7
Week 9
Week 11
Week 13
Week 15
Week 17
Week 19
Week 21
Week 23
Week 25
Week 27
Week 29
Week 31
Week 33
Week 35
Week 37
Week 39
Week 41
Week 43
Week 45
Week 47
Week 49
Week 51
Week 53
Week 55
% AB ad
ministered < 60min before incision
6me
Weekly Run Chart: % AB administered < 60min before incision 6me
% Compliance to prophylaxis: < 60 min
Median: % Compliance to prophylaxis: < 60min
GOAL: 90% compliance to an/bio/cs given 60min before incision /me.
Median: 55%
Start date: 9/4/2013
Week 6: Team leader involvement
Week 14:Posters in theatre: “Timing of
an/bio/c”
Improvement made
Week10: Ink Stamp implemented
Percentage of antibiotics administered before incision (n=147). (9 April 2013 – 31 July 2013).
129
4 87,70% 2,72% 0
20
40
60
80
100
120
140
0-‐60min before incision > 60min before incision
Percentage of antibiotics administered prior to incision per discipline
0
10
20
30
40
50
60
70
0-‐30min 31-‐60min >60min
Series1
Antibiotic choices prescribed for surgical prophylaxis
152
30
10 8 17
11 66,66% 13,16% 4,39% 3,50% 7,46% 4,82%
0
20
40
60
80
100
120
140
160
Cefazolin Amoxicillin/Clavulanic acid
Cefuroxime Cefazolin+gentamycin Clindamycin Other
Dosage of cefazolin prescribed for surgical prophylaxis (n=152).
(9 April 2013 – 31 July 2013).
22,88%
75,82%
0,00%
10,00%
20,00%
30,00%
40,00%
50,00%
60,00%
70,00%
80,00%
1g 2g
Percentage of Duration of Prophylaxis < 24 hours
192
26 11
84,21% 11,40% 4,82% 0
50
100
150
200
250
dura/on < 24hours post op Dura/on <48hours post op dura/on >48hours post op
Days between surgical site infections (94)
(August 2012 - August 2013)
0
10
20
30
40
50
60
70
80
90
100
Days B
etween
CBMH Days between Graph for SSI August 2012-‐2013
Days Between() Median ()
94 days in between
Message for those who wish to start a similar project!
• A project of this size can be daun/ng, be prepared to drive it relentlessly.
• Get surgeons, anaesthe/sts & guidelines (inc dosages)
together at the beginning (if you haven’t done so already)!
• Weekly huddles & regular formal mee/ngs are essen/al. • Publish informa/on & results regularly on the theatre no/ce board & electronically distribute.
In Summary
We have laid the founda/ons of
‘ge;ng it right’!
but need to further drive improvements and ensure sustainability before we can say
‘we have got it right’!
Thank You For Your Time!
No conflicts of interest to declare!
References: 1. David N Gilbert, R. C. (2012). The Sanford Guide to Antimicrobial Therapy 42nd
edition . Sperryville: ANTIMICROBIAL THERAPY INC. 2. Cunha, B. (2012). Antibiotic essentials. New York: Jones & Barlett Learing. 3. Bratzler, D.W.,. 2013. Clinical practice guidelines for antimicrobial prophylaxis in
surgery. Americal Journal of Health-System Pharmacists: (70), pp.195-283 4. Elliot, G. 2013. Guidelines for Surgical prophylaxis in Netcare Hospitals.
Related Documents
