Effectiveness of Workflow Change for Improving the Timing of Prophylactic Antibiotics

Abstract

Objective Prophylactic antibiotics are effective in reducing surgical site infection, especially if administered with appropriate timing. However, the timing of administration in clinical practice is usually suboptimal. This study evaluated the effect of changing workflow to improve the timing and documentation of antibiotic administration. Materials and Methods In a 682-bed regional teaching hospital, the personnel in charge of prophylactic antibiotic administration were changed from ward nurses to operating room nurses and the time of antibiotic administration was recorded on the surgical nursing record starting on April 1, 2006. The effect of workflow change was measured by improvement in the timing of antibiotic administration after the intervention. Patient records were identified by a search of the hospital coding database. A case was defined by a principal or secondary procedure code for six types of surgeries: total hip replacement, total knee replacement, herniorrhaphy, thyroidectomy, hemorrhoidectomy and abdominal hysterectomy. Patients receiving therapeutic antibiotics because of documented preoperative infections were excluded from the study. Appropriate timing was defined as prophylactic antibiotics administered within 2 hours before incision. Patient outcome was assessed by the incidence of surgical site infections. Results During the study period from May 1 to October 31, 2006, 178 patients were enrolled in the study. These patients were compared with 160 patients who had surgery before the intervention period (May 1 to October 31, 2005). A statistically significant improvement in the appropriate timing of administering prophylactic antibiotics was noted between the two periods (41.8% to 78.9%; OR = 5.199; p < 0.001; 95% CI = 3.213–8.413). The number of patients without documentation of timing of prophylaxis decreased significantly from 49.4% to 3.4% (OR = 0.036; p < 0.001; 95% CI = 0.015–0.087). Conclusion The workflow change had a significant effect on improving the timing and documentation of prophylactic antibiotic administration.