Photo of surgical preparation trolley
Preparation for surgery

Designing an intervention

Antibiotic prophylaxis for surgery is critical to reducing surgical site infections. At the same time unnecessarily prolonged prophylaxis harms patients and wastes scarce healthcare resources.

We would now like you to design an intervention for the following scenario:

An audit in your hospital has shown that only 78% of patients undergoing total joint replacement surgery receive antibiotic prophylaxis within one hour of incision in the operating theatre. However 34% of patients who do receive prophylaxis continue this for >24h .

Your intervention needs to improve two aspects of the reliability of administration of prophylaxis:

  • The first dose should be administered within 1h of incision
  • Prophylaxis should not be continued for >24h.

To begin this exercise use the form in the “downloads” to write your notes. In the next step you will be asked to write and submit a 500 word summary of your intervention, based on this information, for peer review.

Firstly, what are your higher order goals? Your intervention is intended to improve the reliability of two care processes so you need to define at least one higher order goal for each of these:

  • Increasing the % of patients who receive surgical prophylaxis within 1h of incision
  • Reducing the % of patients who continue prophylaxis for >24h

Next you need to define what your targets are and these need to be explicit:

  • Increasing the reliability of patients who receive surgical prophylaxis within 1h of incision to >—% within — days/weeks/months
  • Reduce the % of patients who continue prophylaxis for >24h <—% within — days/weeks/months

Next, you need a feedback plan for each of these:

This a section from the table shown in the video in Step 5.10 and concentrates on Feedback reiterating the need for Frequency; Format (written or verbal or both; Delivery (who will this come from) and  Content (what will it look like)

Simple feedback of data about progress towards the goal will result in some improvement but reliability will get stuck at around 80% unless you make changes to the system. You can use “Plan Do Study Act” from the Model for Improvement to structure and report action plans. You should perform multiple PDSA cycles to test system changes.

Don’t forget to consider the learning from this week in relation to the design of your own intervention and use the ‘Design an intervention sheet’ linked below.

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This article is from the free online course:

Antimicrobial Stewardship: Managing Antibiotic Resistance

University of Dundee