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Updated: Jan 25, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
A multifaceted quality improvement project improves intraoperative redosing of surgical antimicrobial prophylaxis
Ashley A Colletti1, Ellen Wang2, Juan L Marquez3
1Division of Pediatric Anesthesia, Department of Anesthesiology and Pain Medicine, Washington and Seattle Children's Hospital, University of Washington, Seattle, Washington.
Insights
Implementing electronic and physical interventions significantly improved intraoperative antibiotic redosing compliance in pediatric surgery. This quality improvement initiative enhanced adherence to weight-based dosing and timing guidelines, reducing infection risks.
Area of Science:
- Pediatric Anesthesiology
- Surgical Site Infection Prevention
- Quality Improvement in Healthcare
Background:
- Accurate intraoperative antibiotic redosing is crucial for preventing surgical site infections in pediatric patients.
- Compliance with national guidelines for weight-based antibiotic redosing presents challenges for pediatric anesthesiologists.
Purpose of the Study:
- To increase compliance with timely and appropriate weight-based antibiotic redosing to 70% in pediatric surgical cases.
- To analyze compliance rates for dose and timing individually, and by order entry method.
Main Methods:
- A quality improvement project was conducted at an academic pediatric hospital between May 2014 and October 2017.
- Phased interventions included electronic countermeasures (dose timing display, alerts, weight-based dose recommendations) and physical countermeasures (badge cards, guideline postings).
- Statistical process control charts and chi-square tests were used to evaluate compliance.
Main Results:
- Overall monthly compliance with antibiotic redosing increased from 4.3% to 73% after interventions (P < 0.001).
- Dose-only compliance rose from 76% to 89% (P < 0.001), and time-only compliance increased from 4.9% to 82% (P < 0.001).
- Electronic order entry was associated with higher dose compliance (90% vs. 86%, P = 0.015).
Conclusions:
- Electronic and physical interventions effectively improved prophylactic antibiotic redosing compliance in pediatric surgery.
- The quality improvement project successfully aligned practice with institutional redosing guidelines.
- Enhanced compliance contributes to better patient outcomes and infection prevention.
Background:
Accurate intraoperative antibiotic redosing contributes to prevention of surgical site infections in pediatric patients. Ensuring compliance with evolving national guidelines of weight-based, intraoperative redosing of antibiotics is challenging to pediatric anesthesiologists.
Aims:
Our primary aim was to increase compliance of antibiotic redoses at the appropriate time and appropriate weight-based dose to 70%. Secondary aims included a subset analysis of time compliance and dose compliance individually, and compliance based on order entry method of the first dose (verbal or electronic).
Methods:
At a freestanding, academic pediatric hospital, we reviewed surgical cases between May 1, 2014, and October 31, 2017 requiring antibiotic redoses. After an institutional change in cefazolin dosing in May 2015, phased interventions to improve compliance included electronic countermeasures to display previous and next dose timing, an alert 5 minutes prior to next dose, and weight-based dose recommendation (September 2015). Physical countermeasures include badge cards, posting of guidelines, and updates to housestaff manual (September 2015). Statistical process control charts were used to assess overall antibiotic redose compliance, time compliance, and dose compliance. The chi-square test was used to analyze group differences.
Results:
A total of 3015 antibiotic redoses were administered during 2341 operative cases between May 1, 2014, and October 31, 2017. Mean monthly compliance with redosing was 4.3% (May 2014-April 2015) and 73% (November 2015-October 2017) (P < 0.001). Dose-only compliance increased from 76% to 89% (P < 0.001), and time-only compliance increased from 4.9% to 82% (P < 0.001). After implementation of countermeasures, electronic order entry compared with verbal order was associated with higher dose compliance, 90% vs 86% (P = 0.015).
Conclusion:
This quality improvement project, utilizing electronic and physical interventions, was effective in improving overall prophylactic antibiotic redosing compliance in accordance with institutional redosing guidelines.
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