Back to Search Start Over

Optimization of Antibiotic Prophylaxis Delivery for Pediatric Surgical Procedures.

Authors :
Yalamanchi P
Parent AL
Baetzel AE
Crowe SM
Gutting AA
Gisondo G
Portice LC
Thorne MC
Wagner DS
Bates KE
Tribble AC
Source :
Pediatrics [Pediatrics] 2021 Aug; Vol. 148 (2). Date of Electronic Publication: 2021 Jul 16.
Publication Year :
2021

Abstract

Objectives: To optimize prophylactic antibiotic timing and delivery across all surgeries performed at a single large pediatric tertiary care center.<br />Methods: A multidisciplinary surgical quality team conducted a quality improvement initiative from July 2015 to December 2019 by using the A3 problem-solving method to identify and evaluate interventions for appropriate antibiotic administration. The primary outcome measure was the percentage of surgical encounters for pediatric patients with appropriate timing of antibiotic administration before surgical incision. Surgical site infection rates was the secondary outcome. Intervention effectiveness was assessed by using statistical process control.<br />Results: A total of 32 192 eligible surgical cases for pediatric patients were completed during the study period. Identified barriers to timely perioperative antibiotic administration included failure to order antibiotics before the surgical date and lack of antibiotic availability in the operating room at the time of administration. Resulting sequential interventions included updating institutional guidelines to reflect procedure-specific antibiotic choices and clarifying timing of administration to optimize pharmacokinetics, creating a hard-stop antibiotic order within electronic health record case requests, optimizing pharmacy and nursing workflow, and implementing an automatic antibiotic prophylaxis timer in the operating room. Administration of prophylactic antibiotics during the recommended preincision time window significantly improved; the correct timing was recorded in 38.6% of preintervention cases versus 94.0% at the conclusion of rollout of the sequential interventions ( P < .001). Surgical site infection rates remained stable.<br />Conclusions: Here we demonstrate utility of the A3 problem-solving schematic to successfully optimize prophylactic antibiotic timing and delivery in the surgical setting for pediatric patients by implementing systems-based interventions.<br />Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.<br /> (Copyright © 2021 by the American Academy of Pediatrics.)

Details

Language :
English
ISSN :
1098-4275
Volume :
148
Issue :
2
Database :
MEDLINE
Journal :
Pediatrics
Publication Type :
Academic Journal
Accession number :
34272341
Full Text :
https://doi.org/10.1542/peds.2020-001669