Methods to improve your surgical antibiotic prophylaxis
One hospital 'rocks' on with antibiotic timing
With high scores on Hospital Compare to back her up, Indun Whetsell, RN, CPHQ, director of quality management at The Regional Medical Center (TRMC) in Orangeburg, SC, says her surgical antibiotic prophylaxis initiatives have paid off in a big way.
Her SCIP project group comprises an anesthesiologist, a CRNA, a surgeon who still practices and works as a quality advisor, surgical services (from same-day services to the operating room to the recovery room), floor representatives from two floors, and a pharmacist. The group, which in the beginning met weekly but now meets monthly, has been integral to the hospital's success.
"It's a no-holds-barred group. It functions by no rules. There's a tremendous level of trust; most of us have been around for a long time, we have a history, and you can critique and professionally disagree and it's fine," she says.
That trust enables a higher-level collaboration, and because the anesthesiologist and physician practice, they function as "great physician champions," which also has been key to success.
In meeting the challenge of always getting the right prophylactic antibiotic, Whetsell says, she developed a cheat card "that has the right antibiotic for the right surgery" and distributed that.
To make the one-hour cut time in dispensing antibiotics preoperatively, she says they began to give antibiotics on the OR table, which has helped, and they added an extra step to the timeout process to ensure the antibiotic is indeed the right one.
When they began, she says the orthopedists were "very reluctant to change their postoperative antibiotic orders." They preferred running antibiotics for 36 hours rather than 24. But she stayed with them on the importance of reducing the time and continued to put the evidence-based literature supporting that right in front of them.
"Today they are phenomenal," she says. "They give us a start time so we don't have any excuses for not doing it right. It's been a tremendous change in practice."
She also began doing more concurrent monitoring, which hadn't been done before, giving the recovery room responsibility for tying up any loose ends. Her mantra has been "did you do everything right for every patient every time?" She maintains a list of doctors from each quarter who achieved "perfect care."
According to Hospital Compare data on TRMC:
- percent of surgery patients who received preventative antibiotic(s) one hour before incision: 92% of 308 patients;
- percent of surgery patients who received the appropriate preventative antibiotic(s) for their surgery: 94% of 313 patients;
- percent of surgery patients whose preventative antibiotic(s) are stopped within 24 hours after surgery: 89% of 299 patients;
- percent of surgery patients whose doctors ordered treatments to prevent blood clots (venous thromboembolism) for certain types of surgeries: 92% of 355 patients;
- percent of surgery patients who received treatment to prevent blood clots within 24 hours before or after selected surgeries to prevent blood clots: 90% of 355 patients.
The two biggest components to her success?
One is keeping literature supporting evidence-based practices in front of the staff who needed to see it.
And two, she says, "We had the right people at the table. We had two physicians who lived and breathed it, who didn't mind physician education. We have a strong clinical group who's not intimidated."
With high scores on Hospital Compare to back her up, Indun Whetsell, RN, CPHQ, director of quality management at The Regional Medical Center (TRMC) in Orangeburg, SC, says her surgical antibiotic prophylaxis initiatives have paid off in a big way.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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