OBJECTIVE: To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis.
DESIGN: A pre- and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures.
SETTING: A 420-bed teaching hospital in the Hamilton-Wentworth region.
PATIENTS: A three-month survey of 901 consecutive patients followed by a two-month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures.
INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation.
MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre- and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated.
RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user-friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis.
CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.