replies

Structure or Process Indicators

List the steps or key pieces that your clinical practice guideline or systematic review suggest that should be in place to improve outcomes (these become your measurements):

Plan for Improvement (for each item listed above, complete the following):

Indicator: The correct prophylactic antibiotics are administered at the right time.

This is key to improving outcomes because: Best available evidence has shown that using the correct antibiotic within the correct time frame is essential in prevention of surgical site infections (Aginga, 2022; Misganaw et al., 2020; Proops, 2019; Spangehl, 2022; WolKhagen et al., 2022).

Operational deKinition: The nurse will check the EMAR for orders for prophylactic antibiotic administration, administer in a timely manner, and request an order if not currently in place.

Numerator: Nursing staff is within 100% compliance with policy to administer prophylactic antibiotics within set time frame. Denominator: All nursing staff

Data collection method

Indicator What data will be collected

1. The correct prophylactic antibiotics are administered at the right time.

Data from patient EMAR / Audit

2. Pre-operation education provided by nursing staff on the importance of home shower.

Competency measured through in- service

3. Post-operative dressing selection is appropriate based on best available evidence.

Audit

4. Pre-screening health assessment performed to assess risks for infection. Electronic patient chart / Audit

5. Theater trafKic limited and time between cases appropriate for sterilization.

Audit

6. Surgeon uses appropriate technique for pre-operative surgical site scrub. Audit

Who Unit RN

What Assesses need for prophylactic antibiotics and contacts MD for orders if necessary.

Where In pre-operative unit.

Why Reducing the risk of postoperative infection.

Goal for this indicator: The unit RN will recognize the need for preoperative prophylactic antibiotics and perform administration within a timely manner.

Benchmark: 100% compliance with administration per EMAR when ordered by MD.

Indicator: Pre-operation education provided by nursing staff on the importance of home shower.

This is key to improving outcomes because: Best available evidence has shown that preoperative shower at home reduces bioKilm and reduces risk of postoperative infection (Aging, 2022).

Operational deKinition: The nurse will preform pre-operative instructions both written and verbal including speciKic instructions for home shower the night before scheduled procedure.

Numerator: Pre-operative patients able to repeat back pre-operative instructions within 90% of accuracy. Denominator: All pre-operative patients

Data collection method

Goal for this indicator: The unit nurse manager will educate the nursing staff on the key pre-operative instructions that the patient needs to know prior to procedure to reduce surgical site infection.

Benchmark: 100% compliancy from unit RNs on in-service participation.

Indicator: Post-operative dressing selection is appropriate based on best available evidence.

This is key to improving outcomes because: Research has shown that selection of the appropriate postoperative dressing is essential in reducing post-operative infections (Chowdhry & Chen, 2015).

Operational deKinition: The surgeon will use the best available evidence to select the most appropriate postoperative dressing.

Numerator: Postoperative patients with dressing selected by surgeon using best available evidence. Denominator: All post-operative patients.

Data collection method

When Prior to being taken to the OR theater.

How Using EMAR and MD paging system.

Who Unit nurse manager

What Provides education for pre-operative instructions for patients

Where On hospital grounds/in person

Why Improve patient pre-operative education

When During pre-operative visit (2-3 weeks prior to procedure)

How Education through lecture and post-test competency during in-service

Who Surgeon

Goal for this indicator: The surgeon will apply best available evidence while choosing post-operative dressing according to policy.

Benchmark: 100% compliance with policy within 30 days of implementation.

Indicator: Pre-screening health assessment performed to assess risks for infection.

This is key to improving outcomes because: Health risks for infection include malnutrition, increased, blood sugar, and smoking. Research has shown that assessment for these risk and preoperative intervention reduces risk of infection (Aginga, 2022).

Operational deKinition: The surgeon will perform a health risk assessment during the pre-operative visit approximately 4-6 weeks prior to surgery.

Numerator: Unit surgeons within 100% compliance with policy to preform health risk assessment. Denominator: All unit surgeons.

Data collection method

Goal for this indicator: The surgeon will preform health risk assessment during pre-operative visit according to policy.

Benchmark: 100% compliance with policy within 30 days of implementation.

Indicator: Theater trafKic limited and time between cases appropriate for sterilization.

This is key to improving outcomes because: Increased theater trafKic and inappropriate theater sterilization has been shown to increase the risk for surgical site infections (Proops, 2019).

Operational deKinition: The unit manager will implement unit protocol for number of times allocated for theater door opening after procedure has started and set time between cases for sterilization.

What Applies best available evidence in selection of postoperative dressing

Where Post-operative recovery

Why To increase compliance with policy to place dressing according to best available evidence.

When In postoperative visit

How Audit

Who Surgeon

What Preforms health risk assessment

Where In-person exam room

Why To identify health risks and provide intervention

When Within 4-6 weeks of procedure

How Electronic patient chart / audit

Numerator: Surgical nurses within 100% compliance of theater trafKic protocol Denominator: All surgical nurses

Data collection method

Goal for this indicator: The unit nurse manager will implement a theater trafKic protocol and use in- service to educate nursing staff on protocol within 30 days.

Benchmark: Surgical nurses within 100% compliance of theater trafKic protocol within 30 days.

Indicator: Surgeon uses appropriate technique for pre-operative surgical site scrub.

This is key to improving outcomes because: Research has shown that scrubbing the surgical site prior to incision reduces risk for surgical site infection (Aginga, 2022).

Operational deKinition: The surgeon will scrub the surgical incision site using best available evidence in accordance with the unit protocol.

Numerator: Unit surgeons within compliance with surgical site scrub protocol. Denominator: All unit surgeons

Data collection method

Goal for this indicator: Unit surgeons will scrub the surgical incision site using best available evidence in accordance with the unit protocol within 30 days if implementation.

Benchmark: 100% compliance with surgical site scrub protocol within 30 days of implementation.

Who Unit nurse manager

What Implement a protocol for theater trafKic

Where On the surgical unit

Why To limit theater trafKic and reduce risk for surgical site infection

When Within 30 days

How Audit

Who Surgeons

What Scrubs the surgical incision site in accordance with unit protocol

Where In operating theater

Why To reduce the risk for surgical site infection postoperatively

When Within 30 days of protocol implementation

How Audit

References Aginga, C. (2022). Surgical site infection: Preoperative evaluation and preventative measures [PDF]. The JBI

EBP Database. https://ovidsp-dc2-ovid-com.pnw.idm.oclc.org/ovid-b/ovidweb.cgi? &S=EICLFPLPOGEBPPGAIPMJBGLENLKCAA00&Link+Set=S.sh.41%7c3%7csl_190

Chowdhry, M., & Chen, A. (2015). Wound dressings for primary and revision total joint arthroplasty. Annals of translational medicine, 3(18), 268. https://doi.org/10.3978/j.issn.2305-5839.2015.09.25

Misganaw, D., Linger, B., & Abesha, A. (2020). Surgical antibiotic prophylaxis use and surgical site infection pattern in dessie referral hospital, dessie, northeast of ethiopia. BioMed Research International, 2020, 1–7. https://doi.org/10.1155/2020/1695683

Proops, E. (2019). Implementing a surgical site infection care bundle: Implications for perioperative practice. Journal of Perioperative Nursing, 32(2). https://doi.org/10.26550/2209-1092.1045

Spangehl, M. (2022). Preoperative prophylactic antibiotics in total hip and knee arthroplasty: What, when, and how. The Journal of Arthroplasty, 37(8), 1432–1434. https://doi.org/10.1016/ j.arth.2022.01.019

WolKhagen, N., Boldingh, Q. J., Boermeester, M. A., & de Jonge, S. W. (2022). Perioperative care bundles for the prevention of surgical-site infections: Meta-analysis. British Journal of Surgery. https://doi.org/ 10.1093/bjs/znac196