SURGICAL CARE IMPROVEMENT PROJECT SCIP

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SURGICAL CARE IMPROVEMENT PROJECT (SCIP)

• Antibiotic Surgical Prophylaxis
• Bunny Isgett-Lynn BSN, RN
• Clinical Applications Coordinator
• VA Gulf Coast Veterans Health Care System,
  Biloxi, MS

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Antibiotic Surgical Prophylaxis

• PROBLEMS
• We were below the benchmark for two mission
  critical measures.
• Mc1d1a (sip 1a) Surgical Care Improvement
  Project (SCIP) Inpatient Prophylactic antibiotic
  received within one hour prior to surgical
  incision (started timely).
• MC1d2a (sip10a) SCIP Inpatient Prophylactic
  antibiotic correct selection.

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Antibiotic Surgical Prophylaxis

• ISSUES
• We have a large turnover of residents rotating
  through on Surgical Rotation, which further
  complicates insuring compliance.
• Once the patient was in the OR, the antibiotic
  was ordered, but delayed the case or arrived too
  late to be given within the time frame.
• Failure to document that the drug was given.
  Nurse thought was not her responsibility because
  Anesthesia gave the medication. Anesthesia
  thought nurse should document.

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Antibiotic Surgical Prophylaxis

• OBJECTIVES
• Establish a multidisciplinary team to develop a
  process that would not only bring us to the
  benchmark, but would allow us to exceed the
  benchmark, thus giving our veterans the ultimate
  in patient care, reducing length of stay, and
  improving post surgical infections!

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Antibiotic Surgical Prophylaxis

• IMPLEMENTATION
• Streamlined and organized the surgery order menu.
  
• Created new surgery menus with new quick orders
  and grouped and categorized them. (This is to
  insure the correct prophylactic antibiotic is
  selected for the correct surgery.)
• This gave the provider, by surgery type, which
  antibiotic to use, the recommended doses, along
  with alternatives for patients with Beta Lactam
  allergies.

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Antibiotic Surgical Prophylaxis

• IMPLEMENTATION
• Developed process that was made mandatory by the
  Chief of Surgery to have all residents/ providers
  review all surgery cases the night prior to
  surgery and order the correct antibiotic that
  evening.
• The orders would print directly to pharmacy.
  Evening pharmacist would prepare the antibiotics
  and deliver them to the OR at 5am day of surgery.
  
• Anesthesia would give and document the proper
  antibiotic with the proper time frame.

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Antibiotic Surgical Prophylaxis

• OUTCOME
• Since implementation, we are very proud to say
  we have been one hundred percent compliant!
  Pharmacy, Surgery, QM, and patients are all very
  pleased with the process. We also involved
  goal-sharing with this project and won the GOLD,
  with bonus bucks!

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Antibiotic Surgical Prophylaxis
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Antibiotic Surgical Prophylaxis

• SURGERY ORDER MENU

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Antibiotic Surgical Prophylaxis

• RESIDENT/PROVIDER GUIDELINES

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Antibiotic Surgical Prophylaxis

• Prophylactic Antibiotics Menu
• Given in the OR
• BEFORE THE CUT!

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Antibiotic Surgical Prophylaxis

• QUICK ORDER

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Antibiotic Surgical Prophylaxis

• Thank you!