Colletti Ashley A, Wang Ellen, Marquez Juan L, Schwenk Hayden T, Yeverino Calida, Sharek Paul J, Caruso Thomas J
Division of Pediatric Anesthesia, Department of Anesthesiology and Pain Medicine, Washington and Seattle Children's Hospital, University of Washington, Seattle, Washington.
Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Paediatr Anaesth. 2019 Jul;29(7):705-711. doi: 10.1111/pan.13651. Epub 2019 May 27.
Accurate intraoperative antibiotic redosing contributes to prevention of surgical site infections in pediatric patients. Ensuring compliance with evolving national guidelines of weight-based, intraoperative redosing of antibiotics is challenging to pediatric anesthesiologists.
Our primary aim was to increase compliance of antibiotic redoses at the appropriate time and appropriate weight-based dose to 70%. Secondary aims included a subset analysis of time compliance and dose compliance individually, and compliance based on order entry method of the first dose (verbal or electronic).
At a freestanding, academic pediatric hospital, we reviewed surgical cases between May 1, 2014, and October 31, 2017 requiring antibiotic redoses. After an institutional change in cefazolin dosing in May 2015, phased interventions to improve compliance included electronic countermeasures to display previous and next dose timing, an alert 5 minutes prior to next dose, and weight-based dose recommendation (September 2015). Physical countermeasures include badge cards, posting of guidelines, and updates to housestaff manual (September 2015). Statistical process control charts were used to assess overall antibiotic redose compliance, time compliance, and dose compliance. The chi-square test was used to analyze group differences.
A total of 3015 antibiotic redoses were administered during 2341 operative cases between May 1, 2014, and October 31, 2017. Mean monthly compliance with redosing was 4.3% (May 2014-April 2015) and 73% (November 2015-October 2017) (P < 0.001). Dose-only compliance increased from 76% to 89% (P < 0.001), and time-only compliance increased from 4.9% to 82% (P < 0.001). After implementation of countermeasures, electronic order entry compared with verbal order was associated with higher dose compliance, 90% vs 86% (P = 0.015).
This quality improvement project, utilizing electronic and physical interventions, was effective in improving overall prophylactic antibiotic redosing compliance in accordance with institutional redosing guidelines.
准确的术中抗生素再给药有助于预防儿科患者的手术部位感染。确保遵守不断演变的基于体重的术中抗生素再给药国家指南对儿科麻醉医生来说具有挑战性。
我们的主要目标是将适当时间和适当基于体重剂量的抗生素再给药依从性提高到70%。次要目标包括分别对时间依从性和剂量依从性进行亚组分析，以及根据首剂医嘱录入方式（口头或电子）进行依从性分析。
在一家独立的学术性儿科医院，我们回顾了2014年5月1日至2017年10月31日期间需要抗生素再给药的手术病例。2015年5月头孢唑林给药方式发生机构性变化后，为提高依从性而采取的分阶段干预措施包括电子对策，用于显示上一次和下一次给药时间、下次给药前5分钟的警报以及基于体重的剂量建议（2015年9月）。物理对策包括胸卡、张贴指南以及更新住院医师手册（2015年9月）。使用统计过程控制图评估总体抗生素再给药依从性、时间依从性和剂量依从性。采用卡方检验分析组间差异。
2014年5月1日至2017年10月31日期间，在2341例手术病例中共进行了3015次抗生素再给药。再给药的平均月度依从性在2014年5月至2015年4月为4.3%，在2015年11月至2017年10月为73%（P<0.001）。仅剂量依从性从76%提高到89%（P<0.001），仅时间依从性从4.9%提高到82%（P<0.001）。实施对策后，与口头医嘱相比，电子医嘱录入的剂量依从性更高，分别为90%和86%（P=0.015）。
这个质量改进项目利用电子和物理干预措施，有效地提高了根据机构再给药指南进行的预防性抗生素再给药总体依从性。
