IV DELIVERY Assigning antibiotic administration to a particular staffer or linking it to required steps can keep it on time.

Are your patients getting their pre-op antibiotics on time? Here's how your colleagues are beating the clock.

Make it someone's job
Assign the delivery of antibiotics to a designated staffer, perhaps rotating the responsibility by day, to create ownership and accountability.

At Hyde Park Surgery Center in Austin, Texas, the OR circulator starts antibiotics on the way to the operating room, says Jami Osterlund, RN, administrative director. The anesthesia provider at the Valley Ambulatory Surgery Center in St. Charles, Ill., starts the antibiotic, either in the OR or while escorting the patient to the OR. "We are 100% compliant with this requirement," says Administrator Deborah Lee Crook, RN, CASC. "Since [anesthesia providers] control to a large extent when the case will start, this has worked well." Your anesthesia provider could also start the antibiotic while conducting the pre-op interview.

No matter who's in charge, communication between pre-op and OR personnel about long cases, late surgeons, patient positioning and other potential variables is key to getting the timing right, says Carol Cappella, clinical director of the Delray Beach (Fla.) Surgery Center.

Besides pushing antibiotics when you're pushing patients to the OR, or assigning it to anesthesia on arrival, the schedule manager can set the pace.

"When the patient is admitted, the antibiotics can be opened and started on time," says Victoria Caillet, RN, CNOR, administrator of the Wooster (Ohio) Ambulatory Surgery Center. The schedule manager can also alert pre-op nurses to backups and when deliveries can commence.

Pre-op nurses can hang the bags as soon as patients are in bays, but Laura Sherer, ADN, BSN, RN, of Cleveland Ambulatory Services in Shelby, N.C., recommends waiting for a sight of the surgeon before delivery. "Do not start antibiotics until the physician comes in to talk to the patient, before going back to surgery," she says. "This ensures that the physician will not be late and the antibiotics will not be given too early."

Perhaps it's even the front-line staffers who have the most reliable information. "Don't administer the antibiotic until the operating room tells you they are ready for the patient," says the administrator of a California surgery center.

Confirm compliance
Whether your antibiotic administration protocol depends on a specific staffer or a step in the pre-op process, reminders can help to ascertain that the doses have been delivered, or still need to be.

"We developed a system whereby the pre-op admitting nurse puts a bright yellow, laminated card on the bed tray stating 'Needs Antibiotic,'" says Julianne Nesselroade, RN, BSN, the pre-op and PACU manager at Gladiolus Surgery Center in Fort Myers, Fla. If the card's gone, it's clear the task's been taken care of.

At Bon Secours St. Francis Health System in Greenville, S.C., patients aren't allowed out of pre-op without their antibiotics. "We have a checklist for all surgery patients to leave pre-op in our EMR and paper charts. It includes signed consent, updated H&P and antibiotics," says Patricia J. Fowler, RN, vice president of surgical services.

In the moments before surgery it's not too late for infection prevention, according to Pat Armstrong, RN, administrator of the Greater Springfield (Mass.) Surgery Center. "Confirming that the antibiotic was given should be part of the time out," she says.

Financial and clinical
As a pre-emptive defense against infection, administering IV antibiotics to patients within 1 hour of the incision ensures a sufficient concentration of the drug in surgical site tissue. Unless you're giving them vancomycin or fluoroquinolones, in which case the rule is within 2 hours. The rule now plays a role in reimbursement. Under Medicare's new quality measures for ASCs, G-codes indicating prophylactic antibiotic activity must be reported on each claim, or else payments will be docked, starting in 2014.