Clinical Pharmacy Forum
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Service or Program: In 2022, our hospital had an increase of surgical site infections that was determined to be partly related to improper preoperative antibiotic choices. Our pharmacy had already implemented a preoperative antibiotic dosing protocol with guidance on dosing for patients, but physicians were choosing inappropriate agents outside this dosing guidance. Reviewing our antibiogram, prescribing patterns, and preoperative antibiotic dosing guidelines, our pharmacy developed a process for reviewing the preoperative antibiotics well-before surgery to ensure time for discussion if agents need to be changed. Weight-based dosing adjustments can also be done at this time. Our pharmacy also highlighted recommendations for cefazolin use, even in penicillin allergic patients, when appropriate. This has led to heightened awareness in our facility regarding its tolerability in penicillin allergic patients and avoidance of unnecessarily broad alternative agents.
Justification/Documentation: Since implementation, our pharmacy team has made > 20 interventions in preoperative antibiotics. The majority of these interventions being an alternative agent recommendation to ensure appropriate coverage and reduce risk of surgical site infections or inappropriate broad-spectrum choices. Our pharmacists present this intervention information quarterly to our P&T committee. No surgical site infections have been identified since protocols implementation.
Adaptability: Using pharmacy review and updated preoperative antibiotic dosing protocol with recommendations from recent literature and our institutional antibiogram, our institution’s process can be replicated easily with solid evidence to ensure appropriate preoperative antibiotic choices are made to ensure a reduction in surgical site infections.
Significance: Using this process and protocol, we have been advancing pharmacy’s position with surgery and surgeons at our facility and educating our staff on appropriate preoperative antibiotic stewardship. We hope this will lead to collaborative agreement or protocol to change antibiotic choices without the need to contact physicians.
Presenting Author
Ron Welch PharmDBaptist Memorial Hospital- GTR
Authors
John Burgess PharmD
Baptist Memorial Hospital- GTR
Monica Mcgill PharmD
Baptist Memorial Hospital-GTR
Samantha Treinish PharmD
Baptist Memorial Hospital-GTR