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Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis
Gina Riggi1, Mayela Castillo, Margaret Fernandez
1Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida.
Background:
Appropriate use of antimicrobials for surgical prophylaxis is an important patient safety issue. Antimicrobial levels should be present during the duration of the surgical procedure until incision site closure. For prolonged surgical procedures in which the tissue concentration of the prophylactic antimicrobial may decrease to below the necessary minimum inhibitory concentration, intraoperative redosing of antimicrobials may be crucial.
Objective:
To evaluate compliance of appropriate intraoperative antimicrobial surgical prophylaxis using real-time intraoperative antimicrobial dosing reminders at a large teaching hospital.
Methods:
A retrospective review of electronic records (March 2009-October 2012) was performed. Patients were included if they were at least 18 years of age and underwent a procedure requiring antimicrobial surgical prophylaxis. Compliance was determined by comparing 3 time intervals: baseline (March 2009-March 2010); intervention period 1 (IP-1; April 1, 2010-April 30, 2012), and intervention period 2 (IP-2; May 1, 2012-October 31, 2012). Interventions included a hospital-wide standardized protocol comprising an automated intraoperative paging system to notify when antimicrobials should be redosed.
Results:
A total of 7,461 of 75,230 surgical procedures required intraoperative redosing of antimicrobials and were analyzed. Patient mean age (± standard deviation) was [Formula: see text] years, and 62.6% were female. The most common procedures that required prophylaxis were solid organ transplantation, neurosurgical procedures, and orthopedic procedures. Baseline compliance (n = 2,183) was 15.8%; compliance significantly improved to 65.3% during IP-1 (n = 4,486; P < .001). The compliance rate improved to 76.7% during IP-2 ([Formula: see text] compared with no reminder).
Conclusions:
Compliance with redosing of intraoperative antimicrobials was improved with the combined approach of guidelines, education to healthcare providers, and real-time automated paging system.
Insights
Implementing real-time automated paging reminders significantly improved intraoperative antimicrobial redosing compliance. This patient safety intervention enhanced surgical prophylaxis protocols in a teaching hospital setting.
Area of Science:
- Infectious Diseases
- Hospital Administration
- Patient Safety
Background:
- Appropriate antimicrobial use for surgical prophylaxis is critical for patient safety.
- Maintaining adequate antimicrobial levels throughout surgery is essential.
- Intraoperative redosing may be necessary for prolonged procedures to prevent sub-therapeutic concentrations.
Purpose of the Study:
- To assess the effectiveness of real-time intraoperative antimicrobial dosing reminders in improving compliance with surgical prophylaxis.
- To evaluate the impact of an automated paging system on intraoperative antimicrobial redosing practices at a large teaching hospital.
Main Methods:
- Retrospective review of electronic health records from March 2009 to October 2012.
- Analysis of 7,461 surgical procedures requiring intraoperative antimicrobial redosing.
- Comparison of compliance rates across baseline, intervention period 1 (protocol + paging), and intervention period 2 (enhanced protocol + paging).
Main Results:
- Baseline compliance with intraoperative antimicrobial redosing was 15.8%.
- Compliance significantly increased to 65.3% after implementing the automated paging system (IP-1).
- Further improvement to 76.7% compliance was observed in the subsequent period (IP-2).
Conclusions:
- A combined strategy of guidelines, education, and real-time automated paging effectively improved compliance with intraoperative antimicrobial redosing.
- Automated intraoperative dosing reminders are a valuable tool for enhancing surgical prophylaxis and patient safety.
- The study demonstrates a successful implementation of technology to optimize antimicrobial stewardship in surgical settings.
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