Cormac T O'Sullivan1, William Kirke Rogers2, Mark Ackman3, Michihiko Goto4, Brian M Hoff5. 1. College of Nursing, University of Iowa Hospital and Clinics, Iowa City, IA. 2. Department of Anesthesia, Carver College of Medicine, University of Iowa Hospital and Clinics, Iowa City, IA. Electronic address: william-k-rogers@uiowa.edu. 3. Office of Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospital and Clinics, Iowa City, IA. 4. Clinical Assistant Professor of Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, Carver College of Medicine and University of Iowa Hospital and Clinics, Iowa City, IA; Infectious Diseases Staff Physician, Iowa City VA Health Care System, Iowa City, IA. 5. Department of Pharmaceutical Care, University of Iowa Hospital and Clinics, Iowa City, IA.
Abstract
BACKGROUND: National guidelines recommend intraoperative redosing of prophylactic antibiotics at defined intervals to reduce the risk of surgical site infections. Compliance with these guidelines is poor. METHODS: A quality improvement project-including education, progress reports, and automated redosing reminders in the anesthesia electronic health record-was implemented at a large university-affiliated hospital to increase rates of intraoperative antibiotic redosing for surgeries lasting more than 4 hours. A retrospective, observational study was then conducted. The primary outcome was the compliance rate with intraoperative antibiotic redosing criteria for all surgeries lasting more than 4 hours in the pre- and post-project period. The effect of the intervention was assessed by an interrupted time-series Poisson regression model. RESULTS: A total of 13,695 surgical procedures were evaluated. Time-series analysis demonstrated that the project was associated with significant improvement of compliance rates (incidence rate ratio [IRR]: 1.16; P = .002) with no significant change in underlying improvement trend (IRR: 1.00; P = .22). DISCUSSION: Few peer-reviewed manuscripts describe effective methods to ensure appropriate antibiotic redosing during prolonged surgeries. We demonstrated that a multipronged approach was very effective at producing immediate and sustained improvements in guideline compliance. CONCLUSIONS: Implementation of a multifaceted intervention improved rates of guideline-concordant redosing of intraoperative prophylactic antibiotics.
BACKGROUND: National guidelines recommend intraoperative redosing of prophylactic antibiotics at defined intervals to reduce the risk of surgical site infections. Compliance with these guidelines is poor. METHODS: A quality improvement project-including education, progress reports, and automated redosing reminders in the anesthesia electronic health record-was implemented at a large university-affiliated hospital to increase rates of intraoperative antibiotic redosing for surgeries lasting more than 4 hours. A retrospective, observational study was then conducted. The primary outcome was the compliance rate with intraoperative antibiotic redosing criteria for all surgeries lasting more than 4 hours in the pre- and post-project period. The effect of the intervention was assessed by an interrupted time-series Poisson regression model. RESULTS: A total of 13,695 surgical procedures were evaluated. Time-series analysis demonstrated that the project was associated with significant improvement of compliance rates (incidence rate ratio [IRR]: 1.16; P = .002) with no significant change in underlying improvement trend (IRR: 1.00; P = .22). DISCUSSION: Few peer-reviewed manuscripts describe effective methods to ensure appropriate antibiotic redosing during prolonged surgeries. We demonstrated that a multipronged approach was very effective at producing immediate and sustained improvements in guideline compliance. CONCLUSIONS: Implementation of a multifaceted intervention improved rates of guideline-concordant redosing of intraoperative prophylactic antibiotics.
Authors: Amit Bardia; Miriam M Treggiari; George Michel; Feng Dai; Mayanka Tickoo; Mabel Wai; Kevin Schuster; Michael Mathis; Nirav Shah; Sachin Kheterpal; Robert B Schonberger Journal: JAMA Netw Open Date: 2021-12-01