Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

4-22-2019

Graduate Advisor

Susan Dean-Baar, PhD, RN, FAAN

Committee

Susan Dean-Baar, PhD, RN, FAAN , Chairperson

Tonya Haynes, DNP, RN

Rachel Wolfe, PharmD

Abstract

Introduction: Prophylactic antimicrobial selection and administration for the prevention of surgical site infections in vascular surgery is a recommended best practice. Non-adherence to published guidelines on the selection and administration of antimicrobials has been observed and may lead to reduced efficacy of antimicrobial prophylaxis.

Methods: An observational, descriptive design was used to study clinician knowledge and behavior and included a retrospective patient record review and provider knowledge survey. A clinical education intervention targeting providers responsible for the selection and administration of antimicrobial prophylaxis was conducted. A repeat patient record review and knowledge survey was completed following the education intervention.

Results: The rate of timely administration of all antimicrobials increased from 69.2% to 88.9% (χ2 = 0.5640, df = 1, p = 0.4526), and for vancomycin from 16.7% to 63.67% (χ2 = 5.3158. df = 1, p = 0.0241). Rate of appropriate selection increased from 76.9% to 83.8% (χ2 = 0.5640, df = 1, p = 0.4526). Knowledge and confidence among clinicians improved in some areas regarding the selection and administration of antimicrobial agents.

Conclusion: This quality assessment and process improvement study demonstrated that with targeted educational experiences and supportive clinical decision-making tools, clinicians responsible for vascular surgery patients can improve their knowledge, selection and timely administration of prophylactic antimicrobials. Implementing these processes into existing pre-operative patient screening/assessment clinics and surgery scheduling mechanisms would hardwire this process setting the stage for clinical outcome trials.

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