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When antibiotic administration within 1 hour of surgery first became a Surgical Care Improvement Project (SCIP) measure in 2005, I remember thinking, "How easy is that?" We were fairly confident that our hospital was very successful with this measure — until we decided to look at the numbers. After a 2-week data collection period, we learned that we weren't giving prophylactic antibiotics within 1 hour of incision in nearly 25% of our surgical cases. Do a little digging at your facility, and you may find similar lapses in compliance. Here are 3 strategies we've implemented to improve our performance.
Include antibiotics in your preset orders. Is the pre-op prophylactic antibiotic part of your surgeons' standardized, predetermined order sets? It should be. This takes the burden of having to obtain the order from the physician on the day of surgery off your pre-op nurse, thereby making it easier to ensure antibiotics are always ordered for every patient ahead of time and ready to be administered in pre-op.
Get anesthesia providers involved. At one point, we had our anesthesia providers administer antibiotics as part of their pre-operative patient evaluations. They were eager to take a more active part in preventing surgical site infections, and this was a fairly successful effort. If you decide to delegate this task to your anesthesia providers, beware of one drawback: Sometimes the antibiotic may be administered more than 1 hour before "cut time" if the previous case is delayed and the patient isn't moved from pre-op to the OR on schedule.
Add it to your time out protocol. In an effort to improve patient safety, we've implemented a time out protocol in the pre-op holding area to verify the patient's identity and procedure before he's brought into the OR. Adding antibiotic administration to this patient safety checklist has proven an effective way of ensuring we never miss this step. The time out that's conducted immediately before leaving the pre-operative holding area involves the entire operative/procedural team engaging in active communication, and both verifying and documenting the following information:
- correct patient identity,
- correct operative side and site,
- agreement on the procedure to be done,
- pre-operative clipping of hair at the operative site (if indicated),
- availability of correct implants and any special equipment or special requirements, and
- prophylactic antibiotics given pre-incision per SCIP recommendations.
If staff responses differ during the time out, the procedure will be placed on hold until the information is reconciled and verified with the team. This pre-operative holding area time out is conducted in addition to a final time out in the operating or procedure room as part of the Universal Protocol, which also verifies that prophylactic antibiotics have been administered within 1 hour of incision. Adding antibiotic administration to the time out protocol conducted in the pre-op holding area has helped increase our rate of pre-op antibiotic prophylaxis.
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Do SCIP Measures Really Prevent Infection? |
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Two recent studies showing an apparent lack of correlation between compliance with Surgical Care Improvement Program measures and the infection rates they're intended to reduce has raised doubts about the program's usefulness. With funding from the U.S. Department of Veterans Affairs, a team of researchers reviewed outcomes from 61,099 surgeries at 112 of the system's hospitals nationwide between 2005 (when the VA adopted the data collection and reporting program) and 2009. According to the study, presented at the American Surgical Association's annual meeting in April, surgical site infection rates remained relatively unchanged at an average of 6.2%, even as compliance with SCIP's infection prevention measures rose over the course of 5 years. The researchers weren't able to conclusively link improved compliance with any of the following 5 measures to reduced SSI rates on either a patient or hospital level:
"SCIP adherence is not informative to third-party payors, administrators or patients," says study author Mary T. Hawn, MD, chief of gastrointestinal surgery at the University of Alabama Birmingham Medical Center. "The policy of continued SCIP measurement for public reporting and payment should be reevaluated." Her findings are similar to a study published by Ohio researchers in the Journal of the American Medical Association a year ago, which also showed no relationship between SCIP compliance and post-op infection rates. — David Bernard |
All hands on deck
Successful antibiotic prophylaxis requires a team effort. That was the overarching lesson we learned from exploring our compliance with this SCIP measure. Your surgeons, anesthesia providers, pre-op and OR nurses all have a role to play in ensuring the right antibiotics are ordered and administered at the right time. It's just one of the many measures we take to shield our patients from infection.
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