Achieving 100 percent compliance to perioperative antibiotic administration: a quality improvement initiative.
- Author:
Sui An LIE
1
;
Kwang Yang Aaron LEE
1
;
Meng Huat GOH
1
;
Sudha HARIKRISHNAN
1
;
Ruban POOPALALINGAM
1
Author Information
- Publication Type:Journal Article
- Keywords: antibiotic prophylaxis; documentation; guideline adherence; reminder system; surgical wound infection
- MeSH: Anti-Bacterial Agents; administration & dosage; Antibiotic Prophylaxis; methods; Documentation; Drug Administration Schedule; Electronic Health Records; Guideline Adherence; Humans; Perioperative Period; Quality Improvement; Reminder Systems; Software; Surgical Procedures, Operative; standards; Surgical Wound Infection; prevention & control
- From:Singapore medical journal 2019;60(3):130-135
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Timely administration of prophylactic antibiotics within 60 minutes before surgical incision is important for reducing surgical site infections. This quality improvement initiative aimed to work towards achieving 100% compliance with perioperative antibiotic administration.
METHODS:We examined the workflow in our Anaesthesia Information Management System (AIMS) and proposed interventions using cause-and-effect analysis of anonymised anaesthetic records from eligible surgical cases extracted from AIMS. This ultimately led to the implementation of an antibiotic pop-up reminder. The overall process was done in a few small plan-do-study-act cycles involving raising awareness, education and reorganisation of AIMS before implementation of the antibiotic pop-up reminder. Data analysis took place from August 2014 to September 2016. Compliance was defined as documented antibiotic administration within 60 minutes before surgical incision, or as documented reason for omission.
RESULTS:The median monthly compliance rate, for 33,038 cases before and 28,315 cases after the reminder was implemented, increased from 67.0% at baseline to 94.5%. This increase was consistent and sustained for a year despite frequent personnel turnover. Documentation of antibiotic administration also improved from 81.7% to 99.3%, allowing us to identify and address novel problems that were initially not apparent, and resulting in several department recommendations. These included administering antibiotics later for cases with predicted longer-than-expected preparation times and bringing forward antibiotic administration in lower-segment Caesarean sections.
CONCLUSION:The use of information technology and implementation of an antibiotic pop-up reminder on AIMS streamlined our work processes and brought us closer to achieving 100% on-time compliance with perioperative antibiotic administration.
