4047F Documentation of order for prophylactic parenteral antibiotics to be given within 1 hour (if fluoroquinolone or vancomycin, 2 hours) prior to surgical incision (or start of procedure when no incision is required) (PERI 2)

Name of the Procedure:

Documentation of order for prophylactic parenteral antibiotics

Summary

This procedure involves documenting an order to administer prophylactic antibiotics through an intravenous (IV) route. These antibiotics must be given within 1 hour prior to a surgical incision (or 2 hours if the antibiotics used are fluoroquinolone or vancomycin), which helps prevent surgical site infections.

Purpose

The goal is to reduce the risk of infections at the surgical site. This precautionary measure is used for patients undergoing surgery to ensure their immune system is bolstered against potential bacterial invasions during the operation.

Indications

This procedure is indicated for patients scheduled to undergo surgical procedures where there is a significant risk of infection. Patient factors include immunocompromised states, diabetes, or surgeries involving implants.

Preparation

Patients may be advised to fast before surgery as part of the standard pre-operative preparation. There may also be specific instructions about stopping certain medications. Diagnostic tests like blood work may be required to assess overall health.

Procedure Description

1. The healthcare provider assesses the patient's need for prophylactic antibiotics.
2. A documentation order is created specifying the antibiotic type and dose.
3. For most antibiotics, it is administered within 1 hour prior to the incision.
4. If using fluoroquinolone or vancomycin, administration occurs within 2 hours before the incision.
5. The medical team ensures the administration is recorded in the patient’s medical records.

Tools/Equipment:

• IV administration set
• Antibiotic solutions
• Sterile preparation materials

Anesthesia/Sedation:

• Not required for administration of the antibiotics, but the surgical procedure may involve anesthesia.

Duration

The documentation and administration process typically takes a few minutes, while the antibiotics need to be given within the 1-2 hour window before surgery.

Setting

The procedure takes place in a hospital surgical unit, outpatient surgical center, or clinic.

Personnel

• Surgeons
• Nurses
• Pharmacists
• Anesthesiologists (for surgical procedures)

Risks and Complications

• Allergic reactions to antibiotics
• Potential for incorrect administration timing

Benefits

The primary benefit is the significant reduction in the risk of surgical site infections. This benefit can be realized immediately post-surgery.

Recovery

There are no specific recovery steps from the antibiotic administration itself, but patients will follow standard post-surgical recovery protocols, which may include monitoring for signs of infection or allergic reactions.

Alternatives

The alternative to prophylactic antibiotics is to manage infections if they occur post-surgically. This can involve higher doses of antibiotics administered for a longer duration.

Pros and Cons:

• Prophylactic approach: Preventive, more effective, and less disruptive.
• Reactive approach: May require longer recovery and pose higher risks of complications.

Patient Experience

Patients usually feel little to no discomfort from the antibiotic administration, which is done through an IV. Post-administration, there may be slight discomfort at the IV site. Pain management and comfort measures will be in place for the surgery itself.