title: Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts.
abstract: BACKGROUND
  Timely prophylactic antibiotic administration aids in preventing postoperative superficial surgical site infections. However, during lengthy surgical procedures, redosing of prophylactic antibiotics may be unintentionally omitted. We assessed the utility of a computerized reminder as part of the anesthesia charting system to increase the rate of timely intraoperative prophylactic antibiotic redosing.
  
  
  METHODS
  A retrospective observational analysis was performed on consecutive patients undergoing non-cardiac surgical procedures at a university-affiliated hospital prior to and after the institution of a computerized reminder system. The reminder system presented the clinician with a series of on-screen dialog boxes prior to the redose time for the specific prophylactic antibiotic administered preoperatively. Antibiotic redosing was defined as appropriate if it occurred within 30 min prior to or after the due time, calculated as twice the half-life of the specific antibiotic. Patients were excluded if the case duration was less than twice the half-life of the administered prophylactic antibiotic, or if no prophylactic antibiotic was given.
  
  
  RESULTS
  A total of 287 cases were included in the study (148 pre-intervention, 139 post-intervention). Patient age, case length, and American Society of Anesthesiologists (ASA) score stratification did not differ between the groups. Use of the reminder system resulted in an increase in the appropriate redosing of antibiotics from 20% prior to institution of the reminder to 58% after institution (p < 0.001).
  
  
  CONCLUSIONS
  A computerized reminder system is an effective tool to assist in appropriate intraoperative redosing of prophylactic antibiotics during lengthy surgical procedures.
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-7115, USA. paul.stjacques@vanderbilt.edu
authors.forename: Paul
authors.initials: P
authors.lastname: St Jacques
authors.forename: Neal
authors.initials: N
authors.lastname: Sanders
authors.forename: Nimesh
authors.initials: N
authors.lastname: Patel
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
authors.forename: Jayant K
authors.initials: JK
authors.lastname: Deshpande
authors.forename: Michael
authors.initials: M
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D004334:Drug Administration Schedule; D006801:Humans; D007430:Intraoperative Care; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D017010:Reminder Systems; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents