2010 Surgical Services Informatics Improvement #1: New Surgical Services Prophylactic Antibiotic Protocol for WFUBMC

JC Gerancher MD Medical Director of

Surgical Services Informatics

Why we have an Institutional Prophylactic Antibiotic Protocol

• All OR personnel share responsibility for decreasing surgical site infections. In addition, we all have responsibility in controlling the proliferation of resistant organisms from unnecessary antibiotic use.

• Choice and Timing of antibiotics used for surgical prophylaxis are part of quality measures under scrutiny by regulatory agencies.

• Documentation of compliance required by these agencies while choosing and timing the best antibiotic(s) is a complex undertaking.

CAUSE = Center for Antibiotic Utilization, Stewardship, & Epidemiology

• This WFUBMC organization is charged with guiding antibiotic choice and timing to best practice based on evidence based medicine, national guidelines, and local patterns of antibiotic susceptibility.

• CAUSE has developed and will maintain a process and database to encourage the choice of best practice for prophylactic antibiotics.

• The Operating Room Information System (ORIS) John Galt will be used to help guide users toward choosing the best antibiotic at the correct time for every patient cared for in the WFUBMC operating room.

Overview of the new institutional protocol for administration of Antibiotics

• The existing “antibiotic page” in JG Anesthesia will be updated and expanded to Holding, Regional, Anesthesia, and PACU applications.

• This page is much smarter and more informative than the current one.

• It ‘autofills’ choice and dose based on age, weight, and all 3000 types of surgical procedures we do.

• A ‘re-dose’ timer will follow each patient from Holding to PACU so that a re-dose reminder will ‘pop-up’.

• Over-ride of CAUSE recommendations is possible but highly discouraged because it will likely result in patient care outside of compliance with best practice.

This is the appearance of the new page in JGAnesthesia

….and often no antibiotic is the correct antibiotic:

This is the appearance of the new view in JGHolding, Regional, and PACU.

A link to antibiotics is present on the first page of each application.

Completion of the antibiotic page is required before creating an EMR.

Completion of the antibiotic screen turns the link from red to green.

RN’s in Holding and Regional will not be expected to initiate antibiotics without MD input.

Anesthesia providers will be expected to initiative recommended antibiotics and re-doses unless directed not to do so by a member of the surgical team.

Charting of all antibiotics should be through this new page only.

Use of recommended antibiotic can be documented with one button click. Please do not free text.

All applications work off a large database table

• The table was created by CAUSE.

• It will be updated by CAUSE and ORIS.

• Antibiotics are based on anatomic location and best practices rather than the preferences of individual clinicians.

All applications now require an age and weight for the antibiotic program to functionWeight and age are necessary for the new antibiotic applications to open.

Age is populated at registration. Weight is now required to be documented as early as possible.

Weight is a tightly controlled piece of data updated and

shared between all John Galt applications through

database linkages.

Weight will auto-fill into your application only after these three things have happened :1. Your patient’s case code is opened in any John Galt application (Intake, Holding, Regional, Anesthesia,

PACU).

2. A weight was entered sometime in the past.

3. Your patient’s case code is then closed in this application at some time before you open yours.

If these three things have not happened at some point before you open your application, you will be prompted to enter a weight.

An estimated weight can be entered in an

emergency situation or when the previous application remains open. Multiple ‘error messages’ will prevent proceeding without documentation of a weight. Complete charting and creation of a medical record requires a weight to be documented.

Prophylactic antibiotic administration is tightly tied to incision time.Anesthesia providers have ‘ownership’ of incision time.

What you enter on the antibiotic page will auto-fill your record on page one and be the incision time in the EMR.

Prompts will encourage documentation of antibiotic administration within 60 minutes of incision time.

Selection of one check box will document with one click the recommended, severe PCN allergic, MRSA, or MRSA+PCN allergic antibiotic (s).

The dose, route, and updated redose time will be documented as well.

Adjustment of dose for neonates and pediatric weight will be made.

The new antibiotic application has a redose timer

• You will be prompted to re-dose antibiotic(s). • Choose “now “or “in ten minutes”.• Re-dosing times are based on the shorter times correct for intra-op use.• The re-dose timer “follows” the patient across applications for the peri-

operative period.• Documentation is accomplished with a single click for recommended

antibiotics.• Re-dosing non-recommended antibiotics is not prompted and requires

manual entry.

Questions or comments:

• Questions or concerns regarding particular CAUSE antibiotics may be referred to Dr Chris Ohl (of CAUSE)

• Questions or concerns about the software may be referred to Dr JC Gerancher or Tammy Brown (of Surgical Services Informatics).

• Questions in real time from users may be referred to ORIS at 6-3661

• User documents, instructions, and discussions are available at: http://sp4.wfubmc.edu/sites/oris