Improvement in the Administration of Preoperative Antibiotics in Total Joint Replacement Surgeries

Abstract

ISSUE: Post-operative infection is a major cause of patient injury, mortality, and healthcare cost. The National Surgical Infection Prevention Medicare Quality Improvement Project and The Medical Letter on Antimicrobial Prophylaxis in Surgery support the surveillance efforts and change in practice. A line listing of the number of total joint replacement surgeries performed in a 1-year timeframe was obtained. We excluded all patients who received vancomycin due to penicillin allergy because this represented only 17% of the total patients receiving pre-operative antibiotics and chose to follow all the patients receiving Ancef. Data revealed pre-operative antibiotics were given incorrectly (outside the 1 hour prior to incision timeframe) 40–60%. PROJECT: An action plan was developed utilizing a root-cause analysis to identify the problems that might impact on the administration of the pre-operative antibiotic in the 1 hour prior to incision timeframe. The actions that were taken included: developing a consistent time to be given (within 1 hour prior to incision), consistent site (all pre-operative antibiotics were to be given in the holding room with the exception of medications that needed a 1 hour infusion time), increase the par levels of stock antibiotics in the holding room, obtain approval from Medical Executive Committee for standardization of administration orders, and education to the staff. RESULTS: After implementation of the action plan, the data revealed a dramatic decrease in the incorrect administration times over the next 3 months, from 40–60% to 0%. LESSONS LEARNED: Consistent open communication with the staff involved helps to identify problems as they occur. Friendly reminder memos were sent out to the managers to share with their staff. Having support from Anesthesia is a must!