Trial to Reduce Antimicrobial Prophylaxis Errors

Summary

Principal Investigator: Stephen Kritchevsky
Abstract: DESCRIPTION (APPLICATION ABSTRACT): Both epidemiologic studies and randomized trials have shown that many surgical site infections (SSI) are preventable with appropriately timed antimicrobial prophylaxis. Patients receiving prophylaxis either well before or well after surgery are up to five times more likely to develop an SSI than those receiving appropriate therapy (Classen et al., 1992). Unfortunately, errors in antimicrobial prophylaxis timing are extremely common, with error rates typically reported to be between 35 and 40 percent. Given that errors in antimicrobial prophylaxis are so common and the consequences of error so grave, identifying methods to assist hospitals in improving prophylaxis must be a high priority. We propose to evaluate a multifaceted, theory-based intervention to assist hospitals in progressing through stages of organizational change to improve the prophylaxis process. We will test the impact of the intervention using a rigorous group-randomized, nested, pretest-posttest design (Murray, 1998). Our specific aims over the four-year project period are: 1) Determine the incidence of medication errors related to antimicrobial prophylaxis for cardiovascular surgery, joint replacement surgery, and hysterectomy in 40 hospitals recruited to participate in the study; 2) identify organizational and system factors associated with error rates; and 3) randomize the 40 hospitals to evaluate the effectiveness of a multifaceted intervention. The intervention consists of a) the promotion of two specific process changes (the elimination of "on-call" ordering and the use of preprinted prophylaxis orders); b) a site visit; c) customized process feedback; d) facilitated benchmarking; and e) peer consultation. The 20 intervention hospitals will be compared with 20 hospitals that receive written feedback of their error rates only. The study has 80-percent power to detect a 12- to 15-percent improvement in the timing of prophylaxis in the full intervention group compared with the group that receives written feedback only. Data collection will be done at each participating hospital, and the medical records of 100 surgical patients before and after the intervention will be abstracted at each hospital to establish performance rates. Changes in the processes of care and the evolution through stages of organizational change will also be assessed. This application represents the combined efforts of three organizations devoted to improving patient care through error reduction: the Society for Healthcare Epidemiology of America, the Joint Commission on Accreditation of Healthcare Organizations, and the Centers for Disease Control and Prevention. Health Care Quality & Effectiveness Research SS KRITCHEVSKY, STEPHEN B. Each organization is providing unique abilities and expertise to address the important issue of antimicrobial prophylaxis errors.
Funding Period: 2002-08-16 - 2007-07-31
more information: NIH RePORT

Top Publications

  1. ncbi The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial
    Stephen B Kritchevsky
    Wake Forest University School of Medicine and J Paul Sticht Center on Aging, Winston Salem, North Carolina
    Ann Intern Med 149:472-80, W89-93. 2008
  2. ncbi Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors
    James P Steinberg
    Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Emory University Hospital Midtown, 550 Peachtree St NE, Rm 5 4403, Atlanta, GA 30308, USA
    Ann Surg 250:10-6. 2009

Scientific Experts

  • Stephen B Kritchevsky
  • James P Steinberg
  • Robert A Salata
  • Jeanne Gaber
  • Joyce Patton
  • Keith Woeltje
  • Ann Schlimm
  • Ronald Cowan
  • Forest Arnold
  • Carol Zuckerman
  • Paul Newell
  • Beth Boersma
  • Malkanthie I McCormick
  • Barbara I Braun
  • Mary Wisniewski
  • Kelley Melton
  • Stephen Hausrath
  • Steve B Kalish
  • Linda Kusek
  • Daniel Craig
  • Anthony Cutrona
  • Nietta Rogers
  • Ghinwa Dumyati
  • Charles Salemi
  • Deborah Houston
  • John P Burke
  • Emily McCraken
  • Bruce Ribner
  • Heidi Hahlen
  • John LaJoice
  • Sylvia Pegg
  • Matt Schuler
  • James M Keegan
  • Gail Morchel
  • James Steinberg
  • Steve Parenteau
  • Brian Koll
  • Bryan Simmons
  • Deborah Ross
  • Walter Hellinger
  • Steven Salas
  • Linda Matrician
  • Michael Pinell
  • Wanda Gillespie
  • John Venglarick
  • Michael F Parry
  • Ruth Carrico
  • Joan Cooper
  • Pablo Mora
  • Leonard Mermel
  • Andrew J Bush
  • Antonio Cabinian
  • Gary Rifkin
  • Joyce Nichlas
  • Jennifer Lee
  • Diane Baranowsky
  • Joni Lancaster
  • Robert Weinstein
  • Teresa Stowasser
  • Edward Robinson
  • Margaret Chambers
  • Michele R Bozikis
  • Ramesh Patel
  • Cristina Cicogna
  • Linda Riley
  • Craig A Martin
  • Linda Greene
  • John Adams
  • Martin Siegel
  • Michele Barron
  • Louis Schenfeld
  • Walter C Hellinger
  • Monica Marchione
  • E Patchen Dellinger
  • Nicole Darr
  • Mary Urso
  • Martin Topiel
  • Jacqueline Morre
  • Monica Maher
  • John Jernigan
  • Dennis Maki
  • Sue Marchione
  • Larry Edwards
  • Jennifer Belavic
  • James W Lederer
  • Carol Ward
  • Ken Ratzen
  • Mari Mangino
  • Ann Bailey
  • Delores Nobles

Detail Information

Publications3

  1. ncbi The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial
    Stephen B Kritchevsky
    Wake Forest University School of Medicine and J Paul Sticht Center on Aging, Winston Salem, North Carolina
    Ann Intern Med 149:472-80, W89-93. 2008
    ..Quality improvement collaboratives are used to improve health care quality, but their efficacy remains controversial...
  2. ncbi Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors
    James P Steinberg
    Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Emory University Hospital Midtown, 550 Peachtree St NE, Rm 5 4403, Atlanta, GA 30308, USA
    Ann Surg 250:10-6. 2009
    ..The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP)...