1. Preventing Surgical Infections Through Effective Perioperative Antibiotic Administration Project Team Members: Anesthesia Infectious Disease Pharmacy Surgical Services Center for Clinical Effectiveness

2. Opportunity Statement Current evidence and expert consensus call for administration of prophylactic antibiotic dosing within 60 minutes of surgical incision. LUHS chart review showed that only 73% of cases received the initial antibiotic within 60 minutes of incision Goal: To ensure that perioperative antibiotics are administered appropriately for all LUHS surgical patients

3. National Focus (CMS/CDC) on Reduction of Surgical Infections Recommended Surgeries: CABG, Other Cardiac, Hip & Knee Arthroplasty, Colon Abdominal & Vaginal hysterectomy, Vascular Performance Measures: 1. Prophylactic antibiotics within 1 hour before surgical incision (current LUHS measure) 2. Antibiotics consistent with current published recommendations (added LUHS measure –11/02) 3. Antibiotics are discontinued within 24 hours after the end of surgery (not measured at this time)

4. Most Likely Causes Accountability for process is not clearly defined (Surgeon, Anesthesia, Nurse) Variation in physician ordering practices Order for antibiotic not written prior to surgery Variable practices of anesthesiologist’s drug administration and documentation

5. Solutions Implemented FY02 Activities Project Team assembled Literature review & data collection Guideline & reference tools developed Un-restriction of Vancomycin Standardized documentation Education of all providers FY03 Activities Guidelines on the EMR Anesthesia record revised Standard order sheets Anesthesia department education Shared results with departments

6. Antibiotic administration prior to surgery has improved

7. Antibiotic appropriateness varies by service

8. Next Steps Education of physicians regarding use of the correct antibiotic Implement standard order sheet in SAC Share results with individual departments Measure use of antibiotics post-operatively Review existing and new surgical order sets to ensure appropriate antibiotic prophylaxis