Degree Awarded Date
December 22, 2022
Background: Small-volume IV antibiotics are commonly administered for surgical prophylaxis, but no clear policy on administration method exists, leading to wide variation in anesthesia provider practice at a large academic medical center. Administration via a secondary tubing set is the recommended practice to minimize significant medication losses which could lead to poor patient outcomes. This large academic medical center performed below the national benchmark for one of these outcomes–surgical site infections.
Goals and Objectives: Objectives of this project included eliminating a potential systematic shortcoming in the administration of prophylactic antibiotics. The goal was to increase the use of secondary tubing techniques for small-volume antibiotics in order to reduce medication losses and waste in administration sets. The expected outcome of this project was 100% provider adoption of the use of secondary tubing for all small-volume antibiotic administration.
Design and Methods: The pre-intervention phase involved observation of provider practices and measurements of medication waste and was followed by an educational intervention for nurse anesthetists on the new policy and best practices for administration of small-volume antibiotics. Following the education, three PDSA cycles were run to evaluate changes in practice and reductions in medication waste over a six-week period. Mean volumes were evaluated using two sample t-tests.
Results: The most common pre-intervention tubing method used was primary tubing (52%), and the most common post-intervention tubing method was secondary tubing (93%). Mean dead volume for these methods were13.45mL and 0.79mL (p
Conclusions: System and person changes were made to foster consistent practice and to potentially prevent poor patient outcomes in the operating rooms at the project site. Providers benefited from the educational intervention by strengthening their clinical practices, and the proposed project intervention required minimal upfront cost with tremendous upside both for cost-reduction and patient well-being.
Torres, Brian DNP, CRNA (Chair) Barnes Jewish College, Goldfarb School of Nursing
Curtis, Mary PhD, ANP-BC, FNP-C, PHCNS-BC (Committee Member) Barnes Jewish College, Goldfarb School of Nursing
Thomas, Benjamin, "Improving Small-Volume Antibiotic Administration for Surgical Prophylaxis" (2023). Doctor of Nursing Practice (DNP) Student Projects. Paper 1.