216 - Proper Antibiotic Administration Timing and SSI Reduction Project
Description: Description of team: Surgical Services RN management, Infection Prevention RN, Infection Disease physician, Anesthesia staff, and perioperative RNs.
Clinical Issue: Correct antibiotics being administered but the proper timing for therapeutic tissue perfusion at incision was lacking. Preparation and planning: Review of literature for timing of preoperative antibiotic administration to achieve tissue perfusion acceptable to protect patients from surgical site infections. A report would have to be generated for audit purposes. One month of surgical cases 120 minutes or greater would be reviewed for baseline compliance prior to start of implementation processes. Education by face-to-face communication and through team email for anesthesia staff support. Education prepared and discussed at team meetings and through email for surgeon support for project. Education prepared for perioperative nursing staff and nursing unit staff. Wording changed to time out form to address the proper preoperative antibiotic timing. Weekly data reported to anesthesia staff. Monthly data reported at surgical services leadership team meeting and infection prevention meeting.
Assessment: Perioperative manager noted during the review of antibiotic redosing times that pre-incision antibiotics were given minutes prior to incision instead of given within therapeutic ranges. This finding was also noted during root cause analysis (RCA) of surgical site infections, with the perioperative manager sharing this information with RCA team. Implementation: Each week, the perioperative manager would audit all cases 120 minutes or greater for initial antibiotic timing and report compliance within therapeutic timing ranges. Outcome: The goal is to achieve 100% compliance of administered antibiotics within proper times to achieve therapeutic tissue perfusion prior to surgical incision. The baseline compliance percentage pre-implementation was 64% and post-implementation compliance for two months data is 77% and 91%.Implications for perioperative nursing: Perioperative nurses play a key role in patient safety. Assisting in the review of proper antibiotic selection and addressing the administration timing for therapeutic tissue perfusion prior to surgical incision is addressed prior to and again at the time out by the perioperative nurse and other surgery team members. Assuring the antibiotic has infused the proper time prior to incision will decrease the risk of surgical site infections and contribute to a safe surgery for every patient.