title: The effect of an interactive visual reminder in an anesthesia information management system on timeliness of prophylactic antibiotic administration.
abstract: BACKGROUND
  To reduce the incidence of surgical site infection, preoperative antibiotics should be administered within 60 min before surgical incision. The purpose of this study was to determine whether adding a visual interactive electronic reminder with a message related to antibiotic administration to our anesthesia information management system would increase compliance with prophylactic antibiotic guidelines.
  
  
  METHODS
  We retrospectively studied electronic anesthesia records of ambulatory and day-of-surgery admission surgical cases in which one of our usual prophylactic antibiotics was administered from June 2004 through December 2005, an interval that includes cases both before and after the February 2005 implementation of the new reminder. Compliance was defined as documented antibiotic administration within 60 min before the surgical procedure starting time. Noncompliant cases were divided into those in which dosing was too early or too late.
  
  
  RESULTS
  Compliance for 4987 cases before and 9478 cases after the reminder was implemented increased from 82.4% to 89.1% (P < 0.01). This increase was found both for attending anesthesiologists assisted by a resident or nurse anesthetist (82.9% before vs 89.1% after, P < 0.01) and for attending anesthesiologists working alone (80.1% before vs 89.3% after, P < 0.01). The improvement in compliance was associated with a decrease in the incidence of antibiotics administered too late (i.e., after surgical incision) (15.2% before vs 8.1% after, P < 0.01), but with no significant change in the incidence of antibiotics administered too early (i.e., more than 60 min before skin incision) (2.4% before vs 2.8% after, P = 0.07).
  
  
  CONCLUSIONS
  The implementation of a visual interactive electronic reminder regarding administration of preoperative antibiotics in an anesthesia information management system was associated with a sustained increase in compliance with surgical prophylactic antibiotic administration timing guidelines.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA. david.wax@mssm.edu
authors.forename: David B
authors.initials: DB
authors.lastname: Wax
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Beilin
authors.forename: Matthew
authors.initials: M
authors.lastname: Levin
authors.forename: Neil
authors.initials: N
authors.lastname: Chadha
authors.forename: Marina
authors.initials: M
authors.lastname: Krol
authors.forename: David L
authors.initials: DL
authors.lastname: Reich
mesh_terms: D000758:Anesthesia / Q000379:methods*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D006801:Humans; D008331:Management Information Systems; D010775:Photic Stimulation / Q000379:methods*; D017010:Reminder Systems; D013530:Surgical Wound Infection / Q000517:prevention & control; D013997:Time Factors