Improving perioperative prophylactic antibiotic prescribing using a novel decision-support tool

Area of Science:

• Medical Informatics
• Infectious Disease Prevention
• Surgical Care Quality

Background:

• Inappropriate selection and dosing of surgical antimicrobial prophylaxis (SAP) contribute to surgical site infections (SSIs).
• Clinical practice for SAP is variable, increasing patient risk.
• A need exists for standardized, evidence-based SAP guidance.

Purpose of the Study:

• To develop and implement a computer decision-support tool for optimizing SAP selection.
• To improve the appropriateness of antibiotic prophylaxis tailored to patient-specific factors.
• To reduce the incidence of SSIs through enhanced SAP practices.

Main Methods:

• A computer decision-support tool was integrated into the electronic health record (EHR).
• The tool provided patient-specific SAP recommendations based on procedure, beta-lactam allergy, MRSA status, and weight.
• Safety of cefazolin for beta-lactam allergic patients was pre-established via a validated questionnaire.

Main Results:

• Appropriate antibiotic administration increased from 77% to 92.5% post-intervention.
• Significant improvements observed in procedure-specific selection and weight-based dosing.
• National Surgical Quality Improvement Program (NSQIP) data indicated a significant decline in SSIs post-intervention.

Conclusions:

• The novel intervention successfully improved appropriate SAP selection across diverse surgical procedures.
• Implementation of the decision-support tool led to a significant reduction in SSIs.
• This approach represents a first-in-class method for directing SAP prescribing based on patient-specific variables.