Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps - 29/09/13
Abstract |
Background |
Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended.
Methods |
A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics.
Results |
Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors.
Conclusions |
Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance.
Le texte complet de cet article est disponible en PDF.Keywords : Antibiotic prophylaxis, SCIP, Surgical site infection, Implementation fidelity, Compliance, Adherence
Plan
| The authors declare no conflicts of interest. |
Vol 206 - N° 4
P. 451-456 - octobre 2013 Retour au numéro
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