| Автор | Collier, Paul, E. |
| Автор | Rudolph, Marilyn |
| Автор | Ruckert, Debra |
| Автор | Osella, Thomas |
| Автор | Collier, Nancy, A. |
| Автор | Ferrero, Marcia |
| Дата выпуска | 1998 |
| dc.description | Ideally antibiotics should be administered preopera tively within 2 hours of skin incision, to ensure adequate tissue concentrations, especially when a vascular pros thesis is used. The quality of patient outcomes may be ad versely affected when key processes, by degrees, fail to meet patient care objectives. This study was designed to incorporate the concepts of total quality management to determine how effectively this goal was achieved, and, after review of those measured results, what process improve ments could be instituted to meet the established re quirements for the administration of antibiotics. The study was then repeated on a yearly basis to determine what ef fect these improvement measures had on antibiotic ad ministration. Three time periods were established for determining when antibiotics were administered. The "early" period was more than 2 hr preoperatively. "Preoperative" was from 2 hr before surgery until the time of incision and "perioperative" was after the time of inci sion. Group 1 consisted of the first 100 patients undergo ing vascular procedures in 1992. After the data were collected, a multidisciplinary team of nurses, pharmacists, and surgeons was assembled to determine the step by step desired process flow from order received to actual med ication administration. The team then reviewed each step of the process to identify variations relative to data ob tained. An action plan was developed to implement the agreed upon improvement plan. After improvements were implemented, groups 2, 3, 4, and 5 consisted of the first 100 vascular procedures of 1993, 1994, 1995, and 1996. Group 1 had only 26% of antibiotics administered during the preoperative period and 74% during the perioperative period. Problems identified were: surgeons ordered the antibiotics when the patient was in the operating room, cefamandole and vancomycin required at least 1 hr to in fuse, nurses were not aware of the need for preoperative infusion, and the pharmacy did not supply the antibiotics in a timely fashion. Educational inservices were held for all parties involved, and cefazolin was used in place of cefamandole because it could be given as a bolus. Results were: group 1, early, 0%; preoperative, 26%; perioperative, 74%; P = N/A; group 2, early, 0%, preoperative, 90%; perioperative, 10%; group 3, early, 7%; preoperative, 93%; perioperative, 0%; group 4, early 0%; preoperative, 100%; perioperative, 0%; and group 5, early, 0%; preoperative, 100%; perioperative, 0%; P = 0.0001 for groups 2-5 (ver sus group 1). It was surprising how often antibiotics were administered incorrectly in a busy vascular practice. By focusing on the process of care delivery, a continuous qual ity improvement team implemented simple changes that resulted in significant improvements. We are now con ducting a study to determine what effect these process im provements had on our infection rate. |
| Издатель | Sage Publications |
| Название | Are Preoperative Antibiotics Administered Preoperatively? |
| Тип | Journal Article |
| DOI | 10.1177/106286069801300208 |
| Print ISSN | 1062-8606 |
| Журнал | American Journal of Medical Quality |
| Том | 13 |
| Первая страница | 94 |
| Последняя страница | 97 |
| Аффилиация | Collier, Paul, E., 25th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Naples, FL |
| Аффилиация | Rudolph, Marilyn, 25th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Naples, FL |
| Аффилиация | Ruckert, Debra, 25th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Naples, FL |
| Аффилиация | Osella, Thomas, 25th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Naples, FL |
| Аффилиация | Collier, Nancy, A., 25th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Naples, FL |
| Аффилиация | Ferrero, Marcia, 25th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery, Naples, FL |
| Выпуск | 2 |
| Библиографическая ссылка | Lindenauer SM , Fry WJ, Schaub G., et al. The use of antibiotics in the prevention of vascular graft infections. Surgery 1967 ;62:487-492. |
| Библиографическая ссылка | Hasselgren P. , Ivarsson L., Risberg B., et al. Effects of prophylactic antibiotics in vascular surgery. Ann Surg 1984;200:86-92 |
| Библиографическая ссылка | Kaiser AB, Clayson KR, Mulherin JL, et al. Antibiotic prophylaxis in vascular surgery. Ann Surg1978;188:283-289. |
| Библиографическая ссылка | Bennion RS, Hiatt JR, Williams RA, et al. A randomized, prospective study of perioperative antimicrobial prophylaxis for vascular access surgery. J Cardiovasc Surg;1985;26:270-274. |
| Библиографическая ссылка | Lalka SG, Malone JM, Fisher DF, et al. Efficacy of prophylactic antibiotics in vascular surgery. An arterial wall microbiologic and pharmacokinetic perspective. J Vasc Surg;1989;10:501-510. |
| Библиографическая ссылка | Burke JFThe effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery1961;50:161-168. |
| Библиографическая ссылка | Claussen DC, Evans RS, Pestotnik SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical wound infections. NEngl J Med1992;326;:281-286. |
| Библиографическая ссылка | Crosby P.The Pragmatic Philosophy of Phil Crosby. Winter Park, FL , 1990 |
| Библиографическая ссылка | Polk HC, Topez-Mayor JF. Postoperative wound infection: A prospective study of determinant factors and prevention. Surgery1969;66:97-103. |
| Библиографическая ссылка | Stone HH, Haney BB, Kolb LD, et al. Prophylactic and preventive antibiotic therapy: timing, duration and economics. Ann Surg1979;189:691-699. |
| Библиографическая ссылка | Senge P.The Fifth Discipline. New York, Doubleday, 1990. |
| Библиографическая ссылка | Roper WL, Winkenwerder W., Hackbarth GM, et al. Effectiveness in health care: An initiative to evaluate and improve medical practice. N Engl J Med1988 ;319:1197-1202. |
| Библиографическая ссылка | Joint Commission on Accreditation of Health Care Organizations. Development and Application of Indicators for Continuous Improvement in Surgical and Anesthesia Care. Oakbrook Terrace, IL, 1991. |
