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Leveraging Quality Improvement Tools to Improve Administration of First-line Surgical Antibiotic Prophylaxis in
Madeline Mock1, David Morris2,3, Jessica Foley4
1From the Department of Quality Improvement, Dayton Children's Hospital, Dayton, Ohio.
Insights
Improving surgical antibiotic prophylaxis (SAP) for patients with penicillin allergies significantly increased first-line SAP use from 25% to 84% in orthopedic and pediatric surgery. This quality improvement initiative enhanced patient safety without increasing surgical site infections.
Area of Science:
- Quality Improvement
- Infectious Disease Prevention
- Surgical Safety
Background:
- Reported penicillin allergies often lead to avoidance of first-line surgical antibiotic prophylaxis (SAP).
- This avoidance increases the risk of surgical site infections (SSIs) in orthopedic and pediatric surgery patients.
- A quality improvement project was initiated to address this gap.
Purpose of the Study:
- To increase the administration of first-line SAP agents to orthopedic and pediatric surgery patients with reported penicillin allergies.
- To reduce the risk of surgical site infections (SSIs) in this patient population.
Main Methods:
- Utilized the Institute for Healthcare Improvement quality improvement methodology.
- Implemented plan-do-study-act cycles focusing on provider education, antibiotic delivery processes, and screening tools.
- Emphasized staff buy-in, electronic medical record utilization, and data transparency.
Main Results:
- Achieved a statistically significant increase in first-line SAP use from 25% to 84% for patients with penicillin allergies.
- Sustained the 84% rate for 9 months, indicating a sustainable process and culture change.
- Observed no adverse medication reactions and no significant increase in SSIs.
Conclusions:
- Targeting antibiotic delivery processes, rather than relying on hard stops, effectively improved SAP usage.
- The project demonstrated a successful and sustainable culture shift in prescribing practices for penicillin-allergic patients.
- Enhanced SAP adherence contributes to improved surgical safety and patient outcomes.
Introduction:
A reported penicillin allergy reduces the likelihood that the patient will receive first-line surgical antibiotic prophylaxis (SAP), which can increase the risk of developing a surgical site infection (SSI). This project aimed to increase the use of first-line SAP agents in orthopedic and pediatric surgery patients with a reported penicillin allergy.
Methods:
The Institute for Healthcare Improvement quality improvement methodology was followed. Key drivers included patient and family awareness of true penicillin allergies, standardization for ordering antibiotics, staff buy-in, electronic medical record utilization, and staff comfort with ordering first-line SAP. Initial plan-do-study-act cycles focused on provider education. Subsequent plan-do-study-act cycles focused on the antibiotic delivery process, antibiotic selection, screening tool development for severe delayed hypersensitivity reactions, education, and data transparency. The outcome measure was the percentage of orthopedic and pediatric surgery patients with a reported penicillin allergy that received first-line SAP per month.
Results:
Since the start of the project in December 2022, there were 2 statistically significant changes in the outcome measure's mean, shifting the mean from 25% to 84% in orthopedic and pediatric surgery patients with a reported penicillin allergy who received first-line SAP. There were no adverse medication reactions and no statistically significant change in SSIs.
Conclusions:
The mean has been at 84% for 9 months showing a sustainable process and culture change regarding first-line SAP usage for orthopedic and pediatric surgery patients. This was achieved through targeting the antibiotic delivery processes without relying on hard stops within the medical record.
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