TY - JOUR
T1 - Interventions dans le dossier médical électronique et administration récurrente d’antibiotiques en phase périopératoire
T2 - une étude avant-après
AU - Hincker, Alexander
AU - Ben Abdallah, Arbi
AU - Avidan, Michael
AU - Candelario, Penka
AU - Helsten, Daniel
N1 - Funding Information:
This work was supported by the Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, MO.
Publisher Copyright:
© 2017, Canadian Anesthesiologists' Society.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Purpose: Perioperative antibiotics decrease rates of surgical-site infections. Numerous interventions have improved administration of the first antibiotic dose; however, failures in the administration of subsequent doses frequently occur. We hypothesized that modifications to the electronic medical record (EMR) would improve the administration of the second antibiotic dose and that such improvements would be sustained over time. Methods: This historical cohort before-and-after study of multipronged alerts in the EMR analyzed 1,348 operations on adult patients. The operations lasted ≥ 240 min, utilized cefazolin as the perioperative antibiotic—constituting 1,348 second and 182 third intraoperative antibiotic doses—and did not involve cardiopulmonary bypass. A decision support intervention provided dosing recommendations when clinicians documented antibiotics. The reminder intervention displayed a continuous bar in the EMR, starting at the time the antibiotics were dosed and ending 15 min before subsequent doses were indicated. The primary endpoints of the study were the change in the proportion of correctly administered second dose of cefazolin, given in accordance with hospital guidelines in the month after implementing the intervention, and whether any improvements declined by three to seven months after implementation. Results: Pre-intervention, 51.4% of second doses of cefazolin were correctly administered. In the immediate post-intervention period, 68.5% were correctly administered, representing a significant absolute improvement of 17.1% (95% confidence interval, 8.1 to 26.1; P < 0.001). Rates did not decline over time; clinicians correctly administered 73.3% of doses in the delayed post-intervention period (P < 0.001 vs pre-intervention). Conclusions: These inexpensive nonintrusive interventions to the EMR provided modest lasting improvements in proper administration of repeated doses of cefazolin. The fact that only approximately 70% compliance was reached highlights the difficulty in addressing this deficiency.
AB - Purpose: Perioperative antibiotics decrease rates of surgical-site infections. Numerous interventions have improved administration of the first antibiotic dose; however, failures in the administration of subsequent doses frequently occur. We hypothesized that modifications to the electronic medical record (EMR) would improve the administration of the second antibiotic dose and that such improvements would be sustained over time. Methods: This historical cohort before-and-after study of multipronged alerts in the EMR analyzed 1,348 operations on adult patients. The operations lasted ≥ 240 min, utilized cefazolin as the perioperative antibiotic—constituting 1,348 second and 182 third intraoperative antibiotic doses—and did not involve cardiopulmonary bypass. A decision support intervention provided dosing recommendations when clinicians documented antibiotics. The reminder intervention displayed a continuous bar in the EMR, starting at the time the antibiotics were dosed and ending 15 min before subsequent doses were indicated. The primary endpoints of the study were the change in the proportion of correctly administered second dose of cefazolin, given in accordance with hospital guidelines in the month after implementing the intervention, and whether any improvements declined by three to seven months after implementation. Results: Pre-intervention, 51.4% of second doses of cefazolin were correctly administered. In the immediate post-intervention period, 68.5% were correctly administered, representing a significant absolute improvement of 17.1% (95% confidence interval, 8.1 to 26.1; P < 0.001). Rates did not decline over time; clinicians correctly administered 73.3% of doses in the delayed post-intervention period (P < 0.001 vs pre-intervention). Conclusions: These inexpensive nonintrusive interventions to the EMR provided modest lasting improvements in proper administration of repeated doses of cefazolin. The fact that only approximately 70% compliance was reached highlights the difficulty in addressing this deficiency.
UR - http://www.scopus.com/inward/record.url?scp=85017630183&partnerID=8YFLogxK
U2 - 10.1007/s12630-017-0885-1
DO - 10.1007/s12630-017-0885-1
M3 - Article
C2 - 28421546
AN - SCOPUS:85017630183
SN - 0832-610X
VL - 64
SP - 716
EP - 723
JO - Canadian Journal of Anesthesia
JF - Canadian Journal of Anesthesia
IS - 7
ER -