Improving Small-Volume Antibiotic Administration for Surgical Prophylaxis:A Quality Improvement Project

No clear policy on administration methods for small-volume intravenous antibiotic bags (< 100 mL) for surgical prophylaxis lead to wide variation in anesthesia provider practice at a large academic medical center. Administration via secondary tubing is the recommended practice to minimize significant medication losses from dead volumes. An observation of current practice and measurements of dead volumes was followed by an educational intervention on best practices for administration of small-volume antibiotics. Three postintervention cycles were conducted to evaluate change in practice and reductions in dead volumes over a 6-week period. Mean dead volume losses were evaluated using one-way ANOVA. Statistically significant (P =.0012) decreases in dead volume losses were observed postintervention, from 8.48 mL (SD 6.80) to 0.93 mL (SD 1.46). The most common pre- and postintervention tubing sets used were primary tubing (pre) and secondary tubing (post). Mean dead volume losses for these respective tubing sets were 13.45 mL (SD 4.74) and 0.79 mL (SD 1.40) (P <.0001). Preintervention administration methods resulted in incomplete antibiotic administration. Overall, there was a significant reduction in dead volumes of antibiotic by changing practice to secondary tubing. With strong provider acceptance and sustained reduction in medication wastage, this intervention has shown to be a beneficial new practice moving forward.