Surgical Site Infection PreventionSurgical Site Infection PreventionOrthopaedic Joint Surgery PatientsOrthopaedic Joint Surgery Patients

Orthopaedic Quality Improvement CommitteeOrthopaedic Quality Improvement CommitteeDr Steven RabinDr Steven Rabin

Dr Anthony RinellaDr Anthony RinellaPaul GorskiPaul GorskiElmer DulceElmer Dulce

Mary VondriskaMary VondriskaMegan GerageMegan Gerage

Victoria Davidson-BellVictoria Davidson-Bell

Project Aim StatementProject Aim Statement

Evidence based research promotes Evidence based research promotes discontinuation of post-operative antibiotics for discontinuation of post-operative antibiotics for total joint patients within 24 hourstotal joint patients within 24 hours

Baseline results as of September 04 for Baseline results as of September 04 for Orthopaedics was 20% compliance Orthopaedics was 20% compliance

Orthopaedics seeks to discontinue antibiotics Orthopaedics seeks to discontinue antibiotics within 24 hours of surgery in accordance with within 24 hours of surgery in accordance with antibiotic administration protocolantibiotic administration protocol

Project GoalsProject Goals

Measurement:Measurement: 100% compliance with antibiotic 100% compliance with antibiotic

discontinuation within 24 hours of surgical discontinuation within 24 hours of surgical incision closureincision closure

100% Compliance with post-op antibiotic 100% Compliance with post-op antibiotic orders: 2 doses of Ancef OR 1 dose of orders: 2 doses of Ancef OR 1 dose of VancomycinVancomycin

Action/Solutions ImplementedAction/Solutions Implemented

Revised post-op order sets Revised post-op order sets Fall 04 changesFall 04 changes

• Ancef 2 doses post-op ORAncef 2 doses post-op OR• Vancomycin 1 dose post-opVancomycin 1 dose post-op

March 05March 05• Revised orders to accommodate EPIC order entryRevised orders to accommodate EPIC order entry

Education ProgramEducation Program ResidentsResidents 5 South Nurses5 South Nurses

Definition: Surgical patients with prophylactic antibiotics discontinued within twenty-four hours after surgery end time / Patients undergoing hip or knee arthroplasty.

Data source: LUMC medical records abstracted by RNs.

Analysis: Seventy-eight percent of hip or knee arthroplasty patients at LUMC now receive discontinuation of prophylactic antibiotics within 24 hours after surgery end. This improvement followed active involvement by the nurse practitioners in orthopedics.

Per

cent

National Hospital Quality MeasuresOrthopedic surgery patients receiving prophylactic antibiotics

discontinued within 24 hours after surgery end time

Month

Apr-0

4 (n

=12)

May

-04

(n=1

8)

Jun-

04 (n

=17)

Jul-0

4 (n

=15)

Aug-0

4 (n

=11)

Sep-0

4 (n

=10)

Oct-0

4 (n

=15)

Nov-0

4 (n

=19)

Dec-0

4 (n

=15)

Jan-

05 (n

=17)

Feb-0

5 (n

=15)

Mar

-05

(n=1

7)

Apr-0

5 (n

=12)

May

-05

(n=1

8)

Jun-

05 (n

=15)

Jul-0

5 (n

=14)

Aug-0

5 (n

=15)

Sep-0

5 (n

=14)

20

40

60

80

100

UCL = 102.89

Mean = 66.17

LCL = 29.45

NP involvement

Revised Post op orders

Post EPIC orderrevisions

Joint surgery patients receiving 2 Ancef Joint surgery patients receiving 2 Ancef doses OR 1 Vancomycin dose post-opdoses OR 1 Vancomycin dose post-op

0

20

40

60

80

100

120

Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06

% C

om

plia

nc

e

AnalysisAnalysis

Statistical significant improvement in Statistical significant improvement in compliance with discontinuation of compliance with discontinuation of antibiotics 24 hours post-opantibiotics 24 hours post-op

Improvement noted with antibiotic Improvement noted with antibiotic administration protocol compliance. Most administration protocol compliance. Most recent month at 88%recent month at 88%

Current BarriersCurrent Barriers

EPIC program constraints for order EPIC program constraints for order entry/medication timingentry/medication timing

Resident attention to detail of post-op Resident attention to detail of post-op orders for antibiotic timingorders for antibiotic timing

Next StepsNext Steps

Continue to:Continue to: Explore EPIC order entry options- for Explore EPIC order entry options- for

physicians and nursesphysicians and nurses Education of physicians and 5 South Education of physicians and 5 South

nursesnurses Ongoing monitoring and sharing of resultsOngoing monitoring and sharing of results

SummarySummary

Compliance with the UHC Surgical Compliance with the UHC Surgical Prevention benchmark goal of antibiotics Prevention benchmark goal of antibiotics ending within 24 hours post op rose from ending within 24 hours post op rose from 74 in 10/05 to 96 % in 1/0674 in 10/05 to 96 % in 1/06

We are almost at our goal of 100% We are almost at our goal of 100% compliancecompliance

Antibiotic administration according to Antibiotic administration according to protocol continues to require continued protocol continues to require continued monitoring and teaching interventionmonitoring and teaching intervention