Background: Implementation of guidelines in daily clinical practice is often suboptimal, mainly due to doctors' poor compliance with them. Perioperative antibiotic prophylaxis (PAP) is many times administered in patients undergoing elective surgery without proper indication or for longer time than needed. Aim of this study is to investigate the effect of a simple intervention on the compliance of the medical staff with the American Society of Health-System Pharmacists (ASHP) guidelines concerning PAP administration. Methods: A prospective 3-month audit took place including routine surgical procedures (laparoscopic cholecystectomy, inguinal hernia repair and thyroidectomy). An intervention aiming to educate the medical staff was implemented. The intervention included the demonstration of a poster and the training of the medical staff over the guidelines. A re-audit recorded the changes in daily clinical practice. Results: The compliance rate regarding the number of PAP doses significantly increased from 0% before the intervention to 68.8% after the intervention for hernia repair and to 53.1% for laparoscopic cholecystectomy. The adherence rate in thyroidectomies increased from 25% to 50%, but without statistical significance. No significant difference was found for other parameters of PAP administration, namely the type of antibiotic used and the timing of the dose administration. Regarding secondary outcomes, hospitalization days were reduced, and cost of antibiotics was significantly decreased (P < 0.05). Conclusions: A simple intervention intending to educate the medical staff was successful in achieving significant improvement on the compliance rate with the PAP guidelines, highlighting the importance of promoting adherence to the already existing, well-established guidelines.

No abstract

Numerous clinical tools have been used for the assessment of consciousness, with the Glasgow Coma Scale (GCS) 1,2 remaining the gold standard. [3][4][5] The Reaction Level Scale 85 (RLS) 6 was developed to surpass some drawbacks of the GCS, namely low interrater reliability, weak delineation of coma, and insufficient patients' coverage (the extent to which the scale cannot be fully implemented, such as the verbal element in intubated patients). 7 The scale includes 8 single-line steps, each representing a level of responsiveness, with levels ≥4 considered comatose. 6,7 In a modified version of the scale, two subcategories of level 3 were later added (Appendix 1). [8][9][10] Despite that it was initially presented as a "better alternative" to the GCS, the RLS never gained wide acceptance. 11 Further, the reliability and validity of the scale have not been proved yet, and its clinimetric properties have not been studied sufficiently. Since it is still in use in a number of top institutions mainly in Scandinavia, 3,12,13 we aimed to investigate whether there is adequate documentation