|
|
The medical center began using the “Antimicrobial Surgical Prophylaxis Order Form” for inpatient surgical procedures in August 2005 as part of the Antimicrobial Stewardship Program.
The form was meant to standardize ordering of pre-and post-operative antimicrobials for prophylaxis in hopes of reducing surgical site infections (SSI), said Mark Rupp, M.D., infectious disease specialist at UNMC and The Nebraska Medical Center.
“Patients who develop an SSI are five-times more likely to be readmitted to the hospital and twice as likely to die as patients who do not develop an SSI,” said Elizabeth Hermsen, Pharm.D., adjunct assistant professor in the UNMC College of Pharmacy, antimicrobial specialist at The Nebraska Medical Center and principal investigator for the study. “The study results demonstrated a significant increase in the percentage of patients who received the appropriate antibiotic for their procedure.”
The study, which was conducted over a six-month period, showed 85 percent of patients received the appropriate antibiotic for their procedures compared to 62 percent before the order form was instituted, Dr. Hermsen said.
Impressive increases also were recorded in the number of patients who received the appropriate dose of antibiotic for their weight — 90 percent compared to 62 percent before the form was implemented — and in the number of patients who were prescribed antibiotics for the appropriate length of time — 89 percent compared to 78 percent before the form was implemented.
The average cost of the antibiotic prophylaxis was significantly less following implementation of the form, Dr. Hermsen said, dropping from $46 to an average of $40 per patient.
“When this incremental savings is multiplied by the thousands of procedures performed at The Nebraska Medical Center yearly, substantial cost savings are accrued,” Dr. Rupp said.
Two things Drs. Rupp and Hermsen would like to see in the future are increased use of and compliance with the form.
Since it was implemented, the form has been used in 70 percent of the applicable surgeries and compliance with the form’s recommendations was 66 percent.
“When the form was used but its recommendations were not followed, patients received the appropriate antibiotic choice, dose and duration at rates similar to or worse than the pre-implementation period,” Dr. Rupp said. “Interestingly, the average cost of antibiotic prophylaxis in the non-compliant group was 32 percent more than the cost associated with use of and compliance with the form.”
Dr. Hermsen said she was thankful for the many surgeons, pharmacists, nurses and other staff members who helped to make the project successful.
“Those who adopted use of the form should be lauded for taking measures that were in the best interests of their patients and the medical center,” she said.