title: A quality management approach to optimizing delivery and administration of preoperative antibiotics.
abstract: OBJECTIVE
  To optimize the process for delivering and administering preoperative antibiotics in order to prevent potential adverse patient outcomes.
  
  
  METHODS
  Using a multidisciplinary quality-improvement team, an evaluation of the preoperative medication order and delivery process was conducted. Charts were reviewed by selected time periods, with winter 1994 discharges for orthopedic surgeries (n = 97) and spring 1995 discharges for open heart procedures (n = 50) being used to arrive at baseline data (n = 147). A plan was devised to mainstream the medication-use process so that it would be standardized hospitalwide. A goal of administering preoperative antibiotics within 30 to 60 minutes prior to cut time was established. Following redesign and education, a repeat chart review of orthopedic surgeries (n = 33) and open heart procedures (n = 168) was conducted during April 1997 for discharges from the same diagnosis-related groups to total (n = 201).
  
  
  METHODS
  A nearly 1,000-bed tertiary referral center and teaching hospital with three separate campuses.
  
  
  RESULTS
  We identified multiple ordering mechanisms, multiple medication sources and delivery sites, multiple administration sites and administering personnel, and other logistical conflicts. Thirty-one percent of cases received antibiotics less than 30 minutes prior to start time, 39% between 30 to 60 minutes, and 30% greater than 60 minutes before start time. Following the multidisciplinary redesign and education, an increase from 39% to 61% receiving preoperative antibiotics between 30 to 60 minutes prior to surgery start time and a decrease from 31% to 18% receiving them in less than 30 minutes was documented. The percentage of patients receiving preoperative antibiotics in 60 minutes or less increased from 70% to 80%.
  
  
  CONCLUSIONS
  A continuous quality-improvement approach that engages all departments involved in patient care is necessary to achieve meaningful change in complicated hospital processes.
authors.affiliation: Department of Medicine, West Virginia University, USA.
authors.forename: L
authors.initials: L
authors.lastname: Welch
authors.forename: A C
authors.initials: AC
authors.lastname: Teague
authors.forename: B A
authors.initials: BA
authors.lastname: Knight
authors.forename: A
authors.initials: A
authors.lastname: Kenney
authors.forename: J E
authors.initials: JE
authors.lastname: Hernandez
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D006302:Health Services Research; D006784:Hospitals, Teaching; D006801:Humans; D015274:Interdepartmental Relations; D008510:Medication Systems, Hospital / Q000458:organization & administration / Q000592:standards*; D009873:Operating Rooms / Q000458:organization & administration; D011300:Preoperative Care / Q000592:standards*; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D013503:Surgery Department, Hospital / Q000458:organization & administration; D013514:Surgical Procedures, Operative / Q000592:standards*; D013530:Surgical Wound Infection / Q000517:prevention & control; D014481:United States