Overview
Boone Health, based in Columbia, Missouri, set out to address issues related to the appropriate discontinuation of antibiotics within 48 hours after cardiovascular surgery. This case study examines the obstacles, actions, and results led by an interdisciplinary team approach.
The Challenges
Boone Health identified an increasing trend in patients receiving antibiotics beyond the recommended 48-hour discontinuation period after surgery. The root cause was traced to a change in the pharmacy department's process, which extended the discontinuation time based on the next scheduled post-operative dose.
The hospital discovered that pre-operative order sets, previously acceptable for post-operative antibiotic administration, were causing extended discontinuation times. The pharmacy department's change in the process exacerbated the issue, leading to an unintended deviation from the recommended antibiotic discontinuation guidelines.
Actions Taken Using the STS National Database
Boone Health focused on interdisciplinary team collaboration, including members from the heart care team, pharmacy, and information services department, to address the issue.
The data management and surgical teams used The Society of Thoracic Surgeon Adult Cardiac Surgery Database registry and clinical evidence from the STS Practice Guideline Series to understand past performance and establish evidence-based guidelines for antibiotic discontinuation. The team modified order sets within the electronic medical record to limit post-operative antibiotic doses to a maximum of two, aligning with the recommended guidelines. The information services team implemented the changes within the order sets specific to cardiovascular patients.
Key to success was utilizing real-time data abstraction to address quality issues promptly rather than waiting for risk-adjusted reports months later. Real-time abstraction enabled timely identification and resolution of quality issues. Effective communication among surgeons, nurse practitioners, and related departments was critical to addressing and resolving quality challenges quickly and efficiently.
Results
The implemented changes yielded positive and measurable results. No further instances of patients receiving antibiotics beyond the 48-hour post-operative window were recorded. Compliance with recommended antibiotic discontinuation guidelines improved significantly. Leveraging data from sources like the STS National Database helped the team make informed decisions, ensure evidence-based practices, and improve patient outcomes.