Increasing Compliance With an Antibiotic Prophylaxis Guideline to Prevent Pediatric Surgical Site Infection
- 1 August 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 262 (2), 403-408
- https://doi.org/10.1097/sla.0000000000000934
Abstract
Objectives: To evaluate an intervention for improving antibiotic prophylaxis (AP) guideline compliance to prevent surgical site infections in children. Background: Although appropriate AP reduces surgical site infection, and guidelines improve quality of care, changing practice is difficult. To facilitate behavioral change, various barriers need to be addressed. Methods: A multidisciplinary task force at a pediatric hospital developed an evidence-based AP guideline. Subsequently, the guideline was posted in operating rooms and the online formulary, only recommended antibiotics were available in operating rooms, incoming trainees received orientation, antibiotic verification was included in time-out, computerized alerts were set for inappropriate postoperative prophylaxis, and surgeons received e-mails when guideline was not followed. AP indication and administration were documented for surgical procedures in July 2008 (preintervention), September 2011 (postintervention), and April–May 2013 (follow-up). Compliance was defined as complete—appropriate antibiotic, dose, timing, redosing, and duration when prophylaxis was indicated; partial—appropriate drug and timing when prophylaxis was indicated; and appropriate use—complete compliance when prophylaxis was indicated, no antibiotics when not indicated. Compliance at preintervention and follow-up was compared using χ2 tests. Results: AP was indicated in 43.9% (187/426) and 62.0% (124/200) of surgical procedures at preintervention and follow-up, respectively. There were significant improvements in appropriate antibiotic use (51.6%–67.0%; P < 0.001), complete (26.2%–53.2%; P < 0.001) and partial compliance (73.3%–88.7%, P = 0.001), correct dosage (77.5%–90.7%; P = 0.003), timing (83.3%–95.8%; P = 0.001), redosing (62.5%–95.8%, P = 0.003), and duration (47.1%–65.3%; P < 0.002). Conclusions: A multifaceted intervention improved compliance with a pediatric AP guideline.Keywords
This publication has 32 references indexed in Scilit:
- The Use of Three Strategies to Improve Quality of Care at a National LevelClinical Orthopaedics & Related Research, 2012
- Patterns of ‘leakage’ in the utilisation of clinical guidelines: a systematic reviewPostgraduate Medical Journal, 2011
- Recent trends in the use of antibiotic prophylaxis in pediatric surgeryJournal of Pediatric Surgery, 2011
- A Novel Approach to Gathering and Acting on Relevant Clinical Information: SCAMPsCongenital Heart Disease, 2010
- Effects of evidence-based clinical practice guidelines on quality of care: a systematic reviewQuality and Safety in Health Care, 2009
- Prophylactic Antibiotic Use: Hardwiring of Physician Behavior, Not Education, Leads to ComplianceJournal of the American College of Surgeons, 2008
- Improving Compliance With Prophylactic Antibiotic Administration GuidelinesAORN Journal, 2007
- An evaluation of antimicrobial prophylaxis in paediatric surgery and its financial implicationJournal of Clinical Pharmacy & Therapeutics, 2005
- Why Don't Physicians Follow Clinical Practice Guidelines?JAMA, 1999
- Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluationsThe Lancet, 1993