503 / Preventing surgical site infections

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Infection control / Prevention of surgical site infections
Early warning There is no specified text here
Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
Antibiotic prophylaxis in surgery is well known as one of the most important action in order to prevent surgical site infections. Nevertheless the analysis of clinical records of patients treated in many surgical units in Italy have shown that antibiotic prophylaxis is often inappropriate because of a wrong choice of the antibiotic, a wrong dosage of it, a wrong timing of its administration and finally the wrong duration of the prophylaxis that frequently becomes an unjustified antibiotic therapy. This project aims to improve antibiotic prophylaxis in surgery ensuring the appropriateness of choosing the right antibiotic, the right dose, the proper timing of administration and the appropriate duration of prophylaxis. This allows to reduce the risk of surgical site infection, the risk of emergence of resistance to antibiotics and finally the cost of prophylaxis
Description of the Patient Safety Practice
 
Analyzing how the antibiotic prophylaxis in surgery was performed in our hospital in 2001, we found a high percentage of inappropriateness in the choice of antibiotic and the timing of administration, which often took place in the ward several hours before surgery. From this analysis we have drawn up guidelines on antibiotic prophylaxis in surgery, then we decided that antibiotics for prophylaxis were ordered directly from the operating room and that the administration was made by the anesthetist at the beginning of the intervention. We have also provided a specific mandatory field in the digital surgical report. In this way, the pharmacist could check which antibiotics were required by the operating rooms of the surgical specialties, blocking all the requests that do not comply with the guidelines until such violations were not justified. Already in 2002, all these improvement actions have brought in a few months, to reach 84% of the overall appropriateness of prophylaxis, with differences between the different surgical specialties, ranging from 49% in gynecology, to 98% in urology.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple local/national health systems
Involved health care staff
 
Physicians
Nurses
Pharmacists
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Patient representative(s)
Patient organisation(s)
Other
Point of time in which service user or their reprasentatives' involvement takes place
During the development of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/practicesdetail.aspx
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Yes
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Giuseppe Vighi
Country: ITALY
Organisation: A.O. `OSP.NIGUARDA CA'GRANDA`-MILANO
E-mail: giuseppe.vighi@ospedaleniguarda.it
Phone: 0264442967
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