Poster Presentation
Thursday, 20 July 2006
10:00 AM - 10:30 AM
Thursday, 20 July 2006
3:00 PM - 3:30 PM
This presentation is part of : Poster Presentations II
A Collaborative Project for the Development of an Antibiotic Protocol for Colon Surgical Procedures
Janet A. Lewis, RN, MA, CNOR and Callie Sue Craig, RN, BSN, CNOR. Surgical Services, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
Learning Objective #1: describe an evidenced based antibiotic protocol for colon surgeries.
Learning Objective #2: list successful strategies for addressing challenges and measuring progress of protocol implementation.

 Introduction of clinical problem:  Prophylactic antibiotic therapy for colon surgeries is a widely accepted practice, however there is not a standard recommended regimen.   Through participation in the National Surgical Infection Prevention Project (SIPP), a large metropolitan hospital had successfully developed antibiotic protocols for cardiovascular and orthopedic procedures. Review of current practices found a wide variance of antibiotic routines for patients undergoing colon surgeries.  Recognizing the inherent challenges in changing physician-established antibiotic ordering practices, an interdisciplinary, collaborative team was assembled to establish a standard protocol.   

The clinical question: 1.What is the current practice for prescribing antibiotics for patients undergoing a colon surgical procedure?  2. What is the evidenced based antibiotic protocol for colon surgeries? 3.What are the challenges for nurses promoting change in physician ordering practice?  4.  What processes would be necessary to address the challenges and to measure progress?  
Search for evidence: Included review of current literature databases (CINAHL, Medline) and recommended practices by the Oklahoma Foundation for Medical Quality (OFMQ) and the American Society of Health-System Pharmacists (ASHP).   
 
Recommendation for the best clinical practice based on the evidence: Methodology included assembling an interdisciplinary team of nursing, pharmacy, infection control and the medical staff to establish an evidenced based colon antibiotic protocol with incorporation into standard orders. Compliance monitoring incorporated review of appropriate antibiotic selection, initiation of antibiotic within 0-60 minutes of incision, and discontinuation of antibiotics within 24 hours after surgery.  Successful implementation strategies included providing research data to Physicians and staff, soliciting a Physician champion, and an introductory letter from the Chair of General Surgery.
 
Implications for practice:  Implementation of a standard protocol reflective of OFMG and ASHP recommended practices deemed effective for improving compliance with Surgical Infection Prevention Project.  Pre-operative antibiotic administration procedure modified to ensure timely medication infusion and enhance patient throughput.
 
 

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