Effect of Therapeutic Guidelines on Surgical Antibiotic Prophylaxis

Mottram, Margaret C; Pearce, Malcolm; Allen, Barbara; Begg, Evan J.

doi:10.1002/jppr1997274290

The Australian Journal of Hospital Pharmacy

1997

DOI: 10.1002/jppr1997274290

|View full text |Cite

Effect of Therapeutic Guidelines on Surgical Antibiotic Prophylaxis

Margaret C Mottram

Malcolm Pearce

Barbara Allen

et al.

Abstract: Aim: To measure compliance with hospital guidelines for surgical antibiotic prophylaxis and estimate the impact on drug costs. Method: The impact of the guidelines introduced in January 1994 was evaluated in all patients undergoing operations during a 7-day period in June 1994 compared with all patients who had operations during a 7-day period in June 1993. The drug costs incurred by non-guideline prescribing were calculated. Results: The proportion of operations using prophylactic antibiotics increased signif… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

1999

2008

Publication Types

Select...

Article4

Relationship

Self Cite0

Independent4

Authors

Journals

Cited by 4 publications

(4 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 Previous reports have identified numerous problems including poor timing, poor documentation, the use of inappropriate antibiotics, and the use of too few or too many doses. [4][5][6] These reports found that compliance with antibiotic guidelines before intervention was 32% in orthopaedic, obstetric and gynaecological and general surgery 4 and 17% in orthopaedic surgery. 6 …”

mentioning

confidence: 99%

See 1 more Smart Citation

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Ritchie

Scanlon²,

Lewis³

et al. 2004

Quality and Safety in Health Care

View full text Add to dashboard Cite

Problem: Antibiotic prophylaxis has been shown to reduce the number of postoperative infections following surgery for hip fracture. At Auckland Hospital the policy for antibiotic prophylaxis for hip fracture surgery is for the patient to receive the first dose of antibiotic at the induction of anaesthesia followed by two more doses at 8 hour intervals. A previous audit found that patients often received too many doses of antibiotic. A retrospective audit was performed of 100 patients undergoing surgery for a hip fracture. The primary problem was over-prescribing; 68 patients (68%) received more than three doses. The number of patients who received three doses according to the guidelines was 29 (29%, 95% CI 21 to 40). Setting: Auckland Hospital which provides acute orthopaedic services for a population of 500 000. Strategy for change: A sticker was introduced with the prescription printed on it. The sticker was applied to the medication chart by the anaesthetist when the initial dose of antibiotic was given. Charts of a further 100 patients were reviewed after the introduction of the sticker and compared with those from another hospital in Auckland where the sticker was not used. Effects of change: The number of patients who received three doses, in accordance with the guidelines, improved to 74 (74%, 95% CI 64 to 82, p,0.001). These changes were observed even though the sticker was only used in 44 patients (44%, 95% CI 34 to 54). At the other hospital the number of patients who received three doses was 10 (20%, 95% CI 10 to 42) and 13 (26%, 95% CI 15 to 40, p = 0.37) for the same two periods. Lessons learnt: The use of a preprinted sticker is a simple intervention which improves the use of antibiotic prophylaxis at the time of surgery. This improvement occurred even though the sticker was used in slightly fewer than half the cases.A ntibiotic prophylaxis is recommended for a wide variety of potentially contaminated surgical procedures and for some ''clean'' procedures, especially when a prosthetic device is implanted. A systematic review found that the use of antibiotic prophylaxis in the operative repair of closed neck of femur fractures was effective in reducing postoperative infections. 1 The relative risk for deep wound infection was 0.36 (95% CI 0.21 to 0.65) when multiple dose antibiotic prophylaxis was compared with placebo or no treatment. 1 The first dose should be administered no more than 2 hours before the initial surgical incision. 2 The optimal duration of antibiotic prophylaxis remains controversial. In hip fracture repair there is evidence to support both the use of a single dose given at induction 3 and for continuing the antibiotics for a total of 24 hours. 1 It is not clear if one approach is better than the other; a meta-analysis showed a relative risk for deep wound infection of 0.4 (95% CI 0.24 to 0.67) when single dose prophylaxis was compared with placebo or no treatment. 1 The administration of antibiotic prophylaxis at the time of surgery is a frequent cause of prescription errors. 4 Pr...

show abstract

mentioning

confidence: 99%

“…[4][5][6] These reports found that compliance with antibiotic guidelines before intervention was 32% in orthopaedic, obstetric and gynaecological and general surgery 4 and 17% in orthopaedic surgery. 6 …”

mentioning

confidence: 99%

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Ritchie

Scanlon²,

Lewis³

et al. 2004

Quality and Safety in Health Care

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Ritchie

2004

Quality and Safety in Health Care

View full text Add to dashboard Cite

show abstract

Surgical Antibiotic Prophylaxis in a Private Hospital Compliance with Guidelines

McConachy

Cuell

Kent

et al. 1999

The Australian Journal of Hospital Pharmacy

View full text Add to dashboard Cite

C o m p lia n ce w ith G u id elin esK e rri A M cConachy, Sylvia C uell, P asch al J K ent, M alcolm I M cD onald ABSTRACT Objective: To prospectively evaluate the appropriate ness of prophylactic surgical antibiotic use and the cost of inappropriate surgical antibiotic prophylaxis in a 115bed private hospital. Method: Details of prophylactic antibiotic administra tion were recorded by operating theatre nursing staff and the clinical pharmacists assessed the appropriate ness of the indication, antibiotic choice and dose. Surgi cal antibiotic prophylaxis was considered appropriate if it met either the in-house Surgical Antimicrobial Pro tocol or the Antibiotic Guidelines 96197 9th edition. We assessed the timing of administration and analysed the cost of inappropriate drug use and laboratory monitor ing. Results: Surgical antibiotic prophylaxis was indicated in 92% of procedures (230/251) and used, or not used, appropriately in 86% of procedures (215/251). In the 197 cases in which antibiotics were indicated and used: only 62% of doses (122/197) were administered at or less than two hours before induction; and the correct antibiotic was chosen in 90% of cases (178/197). Dos age was correct in 77% of cases overall (192/251), but in 98% of cases when the appropriate antibiotic was chosen (174/178). Single doses were employed in only 68% of procedures (133/197). There was compliance with all five criteria in only 35% of cases. T he annual cost to this hospital of inappropriate antibiotic prophy laxis was estimated at over $40 000. Conclusion: This study demonstrated modest compli ance with current recommendations for surgical anti microbial prophylaxis. As a result, the in-house proto col is being revised to include E N T procedures and a new anaesthetic record form is being developed. Fur ther education is being targeted to anaesthetists, urolo gists, orthopaedic, colorectal and E N T surgeons. A ust J H osp Pharm 1999; 29: 5-9.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Effect of Therapeutic Guidelines on Surgical Antibiotic Prophylaxis

Cited by 4 publications

References 7 publications

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Surgical Antibiotic Prophylaxis in a Private Hospital Compliance with Guidelines

Contact Info

Product

Resources

About