title: Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis.
abstract: BACKGROUND
  Appropriate use of antimicrobials for surgical prophylaxis is an important patient safety issue. Antimicrobial levels should be present during the duration of the surgical procedure until incision site closure. For prolonged surgical procedures in which the tissue concentration of the prophylactic antimicrobial may decrease to below the necessary minimum inhibitory concentration, intraoperative redosing of antimicrobials may be crucial.
  
  
  OBJECTIVE
  To evaluate compliance of appropriate intraoperative antimicrobial surgical prophylaxis using real-time intraoperative antimicrobial dosing reminders at a large teaching hospital.
  
  
  METHODS
  A retrospective review of electronic records (March 2009-October 2012) was performed. Patients were included if they were at least 18 years of age and underwent a procedure requiring antimicrobial surgical prophylaxis. Compliance was determined by comparing 3 time intervals: baseline (March 2009-March 2010); intervention period 1 (IP-1; April 1, 2010-April 30, 2012), and intervention period 2 (IP-2; May 1, 2012-October 31, 2012). Interventions included a hospital-wide standardized protocol comprising an automated intraoperative paging system to notify when antimicrobials should be redosed.
  
  
  RESULTS
  A total of 7,461 of 75,230 surgical procedures required intraoperative redosing of antimicrobials and were analyzed. Patient mean age (± standard deviation) was [Formula: see text] years, and 62.6% were female. The most common procedures that required prophylaxis were solid organ transplantation, neurosurgical procedures, and orthopedic procedures. Baseline compliance (n = 2,183) was 15.8%; compliance significantly improved to 65.3% during IP-1 (n = 4,486; P < .001). The compliance rate improved to 76.7% during IP-2 ([Formula: see text] compared with no reminder).
  
  
  CONCLUSIONS
  Compliance with redosing of intraoperative antimicrobials was improved with the combined approach of guidelines, education to healthcare providers, and real-time automated paging system.
authors.affiliation: Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida.
authors.forename: Gina
authors.initials: G
authors.lastname: Riggi
authors.forename: Mayela
authors.initials: M
authors.lastname: Castillo
authors.forename: Margaret
authors.initials: M
authors.lastname: Fernandez
authors.forename: Andrew
authors.initials: A
authors.lastname: Wawrzyniak
authors.forename: Michael
authors.initials: M
authors.lastname: Vigoda
authors.forename: Scott
authors.initials: S
authors.lastname: Eber
authors.forename: David
authors.initials: D
authors.lastname: Lubarsky
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Abbo
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017010:Reminder Systems; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents