ERAS: Safety checklists, antibiotics, and VTE prophylaxis

Moffatt-Bruce, Susan D.; Hilligoss, Brian; Gonsenhauser, Iahn

doi:10.1002/jso.24790

Cited by 9 publications

(6 citation statements)

References 51 publications

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“…Clinical pathways such as enhanced recovery after surgery (ERAS) protocols are well-established multi-disciplinary approaches that have been successfully implemented across hospital services worldwide [37, 38]. SAP administration is a common component of ERAS Society recommendations for peri-operative care[37, 39, 40] However, clarification of post-operative antibiotic management is omitted.…”

Section: Discussionmentioning

confidence: 99%

“…laryngectomy, total knee arthroplasty and orthognathic surgery). A review of ERAS in relation to antibiotic use by Moffat-Bruce et al[38] proposed that the application of surgical guidelines within ERAS protocols and its expansion into the EMR environment would improve clinical workflow and reduce errors. Specific examples include: the development of order sets and dynamic orders for specific antimicrobial courses with procedure specific durations and stop times to be entered prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

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Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

et al. 2019

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BackgroundSurgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in the hospital setting, with demonstrated high rates of inappropriateness. Decision-making for SAP is complex and multifactorial. A greater understanding of these factors is needed to inform the design of targeted antimicrobial stewardship interventions and strategies to support the optimization of SAP and its impacts on patient care.MethodsA qualitative case study exploring the phenomenon of SAP decision-making. Focus groups were conducted with surgeons, anaesthetists, theatre nurses and pharmacists across one private and two public hospitals in Australia. Thematic analysis was guided by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivators-Behaviour (COM-B) model.ResultsFourteen focus groups and one paired interview were completed. Ten of the fourteen TDF domains were identified as relevant. Thematic analysis revealed six significant themes mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes identified were: 1) Low priority for surgical antimicrobial prophylaxis prescribing skills; 2) Prescriber autonomy takes precedence over guideline compliance; 3) Social codes of prescribing reinforce established practices; 4) Need for improved communication, documentation and collection of data for action; 5) Fears and perceptions of risk hinder appropriate SAP prescribing; and 6) Lack of clarity regarding roles and accountability.ConclusionsSAP prescribing is a complex process that involves multiple professions across the pre-, intra- and post-operative surgical settings. The utilisation of behaviour change frameworks to identify barriers and enablers to optimal SAP prescribing supports future development of theory-informed antimicrobial stewardship interventions. Interventions should aim to increase surgeon engagement, enhance the prioritisation of and accountability for SAP, and address the underlying social factors involved in SAP decision-making, such as professional hierarchy and varied perceptions or risks and fears.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

et al. 2019

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“…To facilitate appropriate SAP prescribing, there is a need to support prescribing quality data benchmarking, and to develop the ability to link appropriateness of SAP use to patient outcomes (such as surgical site infections, readmission, mortality, sepsis and Clostridioides difficile infection). Opportunities to capitalize on existing workflows , such as the ‘time-out’ process 73 and the enhanced recovery after surgery (ERAS) protocol, 74 to support SAP prescribing were identified. Cultural barriers to AMS for SAP prescribing, such as the influence of professional hierarchy, and fears and risk perception, can be addressed through leadership engagement and evidence-based reinforcement of information on patient safety and quality of care.…”

Section: Acute Care (Hospitals)mentioning

confidence: 99%

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

Thursky

Hardefeldt

Rajkhowa

et al. 2021

JAC-Antimicrobial Resistance

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Antimicrobial stewardship (AMS) in Australia is supported by a number of factors, including enabling national policies, sectoral clinical governance frameworks and surveillance programmes, clinician-led educational initiatives and health services research. A One Health research programme undertaken by the National Centre for Antimicrobial Stewardship (NCAS) in Australia has combined antimicrobial prescribing surveillance with qualitative research focused on developing antimicrobial use-related situational analyses and scoping AMS implementation options across healthcare settings, including metropolitan hospitals, regional and rural hospitals, aged care homes, general practice clinics and companion animal and agricultural veterinary practices. Qualitative research involving clinicians across these diverse settings in Australia has contributed to improved understanding of contextual factors that influence antimicrobial prescribing, and barriers and facilitators of AMS implementation. This body of research has been underpinned by a commitment to supplementing ‘big data’ on antimicrobial prescribing practices, where available, with knowledge of the sociocultural, technical, environmental and other factors that shape prescribing behaviours. NCAS provided a unique opportunity for exchange and cross-pollination across the human and animal health programme domains. It has facilitated synergistic approaches to AMS research and education, and implementation of resources and stewardship activities. The NCAS programme aimed to synergistically combine quantitative and qualitative approaches to AMS research. In this article, we describe the qualitative findings of the first 5 years.

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“… 15 Although, in the United States, hospitals are given financial incentives for low rates of VTE in hospitalized patients, hospitals that have a very high rate of VTE will not get reimbursed for their services. 15 …”

Section: Introductionmentioning

confidence: 99%

“…14 Unfortunately, despite developing clinical guidelines, many hospitals lack a checklist for patient assessment to prevent VTE, and many hospitalized patients do not get appropriate VTE prophylaxis. 15 Although, in the United States, hospitals are given financial incentives for low rates of VTE in hospitalized patients, hospitals that have a very high rate of VTE will not get reimbursed for their services. 15 To our knowledge, no studies have been conducted in Palestine to assess the usual practice of VTE prophylaxis and anticoagulant use among hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

VTE Prophylaxis Therapy: Clinical Practice vs Clinical Guidelines

Abukhalil¹,

Nasser²,

Khader³

et al. 2022

VHRM

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Introduction Venous thromboembolism (VTE) is the most preventable complication in hospitalized patients. The main objective of this study was to evaluate the adherence of current clinical practice to the established guidelines at a Palestinian teaching hospital. Methods This cross-sectional, retrospective, observational study was conducted at a Palestinian Teaching Hospital. The medical records of patients admitted to the medical floor over 18 years of age and hospitalized for longer than 24 hours between January 1 and May 31, 2019, were included. Patients taking anticoagulants with incomplete or duplicated medical records were excluded from the study. A data collection sheet was developed, and clotting and bleeding risks were assessed using the Padua and IMPROVE risk assessment models (scores). The data were analyzed using IBM SPSS (version 25). Results In total, 408 patients were included in the study, 222 of whom received thromboprophylaxis (54.4%). Of the hospitalized patients, 112 (27.5%) had a high risk of developing VTE (Padua score ≥ 4), and 73 patients were eligible for VTE pharmacological prophylaxis; however, only 44 (60.3%) received the appropriate prophylaxis. In addition, 296 patients had low Padua scores, indicating that pharmacological prophylaxis was not indicated. However, 144 (48.6%) patients received prophylaxis. The mean Padua and IMPROVE risk scores were 2.25 ± 2.08 and 4.44 ± 2.72, respectively. Among the patients, 17.6% had a high risk of bleeding (IMPROVE score ≥ 7). Conclusion VTE prophylaxis among hospitalized medically ill patients was mostly inappropriate; 80.18% of the patients received inappropriate prophylaxis, and only 60.3% of eligible patients received appropriate prophylaxis. Adapting assessment models or checklists in clinical practice based on clinical guidelines for VTE risk stratification is a practical and effective method to improve VTE prophylaxis management and select the appropriate therapy to prevent toxicity or complication.

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ERAS: Safety checklists, antibiotics, and VTE prophylaxis

Cited by 9 publications

References 51 publications

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

VTE Prophylaxis Therapy: Clinical Practice vs Clinical Guidelines

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