Antibiotic prescribing practices in general surgery: a mixed methods quality improvement project

Area of Science:

• Surgical infection prevention
• Antimicrobial stewardship
• Quality improvement in healthcare

Background:

• Optimal surgical site infection (SSI) prophylaxis involves a single pre-operative antibiotic dose.
• Adherence to SSI prophylaxis guidelines remains inconsistent.
• A quality improvement project was implemented to enhance guideline adherence for antibiotic prescribing in a tertiary hospital surgical setting.

Purpose of the Study:

• To improve adherence to guideline-driven antibiotic prescribing practices among surgical teams.
• To reduce the incidence of prolonged post-operative antibiotic use.
• To evaluate the effectiveness of a novel intervention in promoting appropriate antibiotic prophylaxis.

Main Methods:

• Qualitative data on prescriber perceptions and attitudes were gathered through interviews and anonymous surveys.
• An intervention was developed, incorporating a daily ward-round checklist (ABBDDOMM) and educational components.
• Two audit cycles were conducted, comparing antibiotic prescribing before and after intervention implementation in patients undergoing intra-abdominal surgery.

Main Results:

• Interviews identified key barriers to appropriate antibiotic prescribing.
• The intervention led to a significant reduction in prolonged antibiotic courses, from 48.8% to 29.7% (21.5% decrease, P<0.0005).
• Antibiotic prescribing compliance with Trust Guidelines increased from 52.2% to 58.0% post-intervention.

Conclusions:

• A checklist combined with antimicrobial stewardship education effectively reduces inappropriate post-operative antibiotic prescribing.
• Sustained use of checklists by junior doctors is crucial for continued improvement.
• Further efforts are needed to enhance the uptake of pre-operative antibiotic induction guidelines.