Bardia Amit, Melnick Edward R, McCall Terika, Zhao Xiwen, Lin Hung-Mo, Fisher Clark, Burg Matthew M, Schonberger Robert B
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Anesthesiology. 2025 Mar 1;142(3):489-499. doi: 10.1097/ALN.0000000000005302. Epub 2024 Nov 18.
Antibiotics play a crucial role in preventing surgical site infections, yet adherence to Infectious Disease Society of America guidelines varies widely. This qualitative study aimed to explore factors influencing perioperative antibiotic administration and assess the potential impact of a clinical decision support tool on guideline adherence.
In this qualitative study, perioperative personnel with diverse roles (surgeons, anesthesiologists, certified nurse anesthetists, trainees, and pharmacists) were interviewed using a semistructured interview format from September 2023 through April 2024. Interviews were then analyzed for codes, which were assigned to concepts using the constant comparison method for assessment of factors that were described as barriers or facilitators of guideline adherence.
After 3 piloting interviews, 9 sessions were conducted with a total of 17 participants: 7 attending anesthesiologists, 3 resident trainees, 2 perioperative pharmacists, 3 Certified Registered Nurse Anesthetists, and 2 attending surgeons. Key themes emerged: (1) limited familiarity with Infectious Disease Society of America antibiotic guidelines, (2) lack of standardization and optimization of antibiotic decision-making process, (3) challenges with managing β-lactam allergies, (4) difficulty optimizing vancomycin timing, and (5) perceived benefit of a clinical decision support tool in enhancing workflow and guideline adherence.
Nonadherence to antibiotic guidelines in the perioperative setting often results from a lack of structured workflow. The interviews provide a foundation for developing a clinical decision support tool tailored to provider needs, aiming to improve user satisfaction and promote better adherence to perioperative antibiotic guidelines.
抗生素在预防手术部位感染方面发挥着关键作用，但对美国传染病学会指南的遵循情况差异很大。这项定性研究旨在探讨影响围手术期抗生素使用的因素，并评估临床决策支持工具对指南遵循情况的潜在影响。
在这项定性研究中，从2023年9月至2024年4月，采用半结构化访谈形式对不同角色的围手术期人员（外科医生、麻醉医生、注册护士麻醉师、实习生和药剂师）进行了访谈。然后对访谈进行编码分析，使用持续比较法将编码分配给各种概念，以评估被描述为指南遵循的障碍或促进因素的因素。
在进行了3次试点访谈后，共进行了9次访谈，涉及17名参与者：7名主治麻醉医生、3名住院实习生、2名围手术期药剂师、3名注册护士麻醉师和2名主治外科医生。出现了关键主题：（1）对美国传染病学会抗生素指南的熟悉程度有限，（2）抗生素决策过程缺乏标准化和优化，（3）β-内酰胺类过敏管理存在挑战，（4）万古霉素给药时机优化困难，（5）临床决策支持工具在改善工作流程和指南遵循方面的潜在益处。
围手术期不遵循抗生素指南通常是由于缺乏结构化的工作流程。这些访谈为开发满足医疗服务提供者需求的临床决策支持工具奠定了基础，旨在提高用户满意度并促进更好地遵循围手术期抗生素指南。
