Improving antibiotic stewardship: Order set implementation to improve prophylactic antimicrobial prescribing in the outpatient surgical setting

In the landmark document Crossing the Quality Chasm, the Institute of Medicine lists 6 aims of healthcare, one of which is that healthcare has to be effective. One means of improving the effectiveness of healthcare includes the creation of evidence-based guidelines to help streamline processes, decrease variability in care, and improve outcomes. Postoperative infection constitutes one of the most common preventable complications for surgical patients. The practice of administering perioperative antibiotics is currently being examined to determine the most effective approach to decrease the incidence of surgical site infections, improve resource utilization, and meet Surgical Care Improvement Project (SCIP) mandates. We utilized a tailored antibiotic prophylaxis form to help standardize perioperative antimicrobial use. The form was modified by a multidisciplinary antibiotic committee as new published clinical evidence or new SCIP guidelines were produced. We demonstrated a more than 90% compliance with SCIP core measures and significantly decreased the variability of antibiotic-ordering practices within our institution. Pharmacy savings are estimated at $8500 per year on surgical prophylaxis using the most commonly prescribed antimicrobials. Compliance with timely (within 1 hour prior to incision) antimicrobial administration is more than 90% but remains with high variability. Improvement in documentation may decrease the perceived inconsistencies in timing. Our results demonstrate that a multidisciplinary approach to managing perioperative prophylactic antimicrobial can be effective in decreasing clinical variability and costs of perioperative care, while increasing compliance with national mandates for antibiotic prescribing.