Implementation and Evaluation of a Preprinted Perioperative Antimicrobial Prophylaxis Order Form in a Teaching Hospital

Abstract

P Au, S Salama, C Rotstein. Implementation and evaluation of a preprinted perioperative antimicrobial prophylaxis order form in a teaching hospital. Can J Infect Dis 1998;9(3):157-166. OBJECTIVE:To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis. DESIGN: A pre-and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures. SETTING: A 420-bed teaching hospital in the Hamilton-Wentworth region. PATIENTS: A three-month survey of 901 consecutive patients followed by a two-month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures. INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation. MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre-and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated. RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user-friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis. CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.Key Words: Antimicrobial therapy, Order form, Perioperative, Prophylaxis voir page suivante P rescription drugs contribute significantly to hospital expenditures and account for approximately 5% to 20% of a hospital's global budget (1). Antimicrobial agents constitute a substantial proportion of a hospital's drug inventory (about 25%) (2) and drug acquisition budget (20% to 50%) (3,4). However, because of the perception that antimicrobial agents are associated with low risk of toxicity, these therapeutic drugs have resulted in varying degrees of inappropriate use (5-13). Therefore, it is not surprising that these drugs have received increasing scrutiny during an era of cost containment (14,15).Surgical site infections account for up to 24% of nosocomial infections (16). Consequences of these infections include comprom...

An Integrated Approach to Antimicrobial Stewardship in the Hospital Setting

“…This method has been employed very successfully by the authors to decrease inappropriate prescribing of perioperative antimicrobial prophylaxis (44). Not only did the perioperative antimicrobial prophylaxis order form promote the appropriate use of antimicrobials for surgical prophylaxis, but it standardized prophylactic regimens, ensured the timely administration of the prophylactic agents, had a long lasting effect and reduced drug acquisition costs.…”

“…The use of antimicrobial order forms, which are often used in combination with other strategies (44), is a significant component of an integrated stewardship program. Order forms permit the collection of data for DURs because they contain written justification of antimicrobial use; however, the quality of the information gathered is dependent on those filling in the forms and, therefore, may be of limited use.…”

“…Pestotnik and coworkers (5,13) used computer-assisted decision support to improve the timing and duration of antimicrobial perioperative prophylaxis while simultaneously decreasing antibioticassociated adverse events by 30%. Similarly, two of the authors (CR and SS) employed a perioperative antimicrobial order form to improve the appropriateness and timing of prophylactic regimens (44). The evaluation of outcomes based on quality of care measurements are preferred to ensure future improvements in patient care.…”