Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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A N T I B I O T I C D E L I V E R Y start time appropriately. Cases that patients have, if any, double-check medication orders to see what drugs are needed 4. Read and react demand challenging patient positioning — and hang antibiotic IV bags on patients' There are recommended antibiotics for for example, one of our surgeons prefers stretchers. When the circulating nurse certain procedures. Patients undergoing his rotator cuff patients in the lateral posi- arrives to interview the patients and take orthopedic surgery, for example, typically tion — or waiting for additional surgical them to the OR, have her confirm the receive cephalosporin. If patients are aller- team members to help position obese physicians' orders, begin the antibiotic gic to penicillin, they usually receive van- patients can also delay surgery starts. In infusions and document the start times as comycin. Keep in mind that vancomycin these cases, waiting to start the antibiotic she signs the pre-op checklists. (The nurs- and fluoroquinolones must be delivered in the OR might be necessary in order to ing mantra "You didn't do it if you didn't within 2 hours of incision time — not the fall within the required delivery window. chart it" is never truer than it is today.) typical 60 minutes. In these instances, you OSM We've found that starting the drip in the might not be able to wait for your circula- pre-op holding area, about 30 minutes tor to start the antibiotic IV. Have your pre- before taking the patient to the OR, the op nurses alert the circulator that a 2-hour antibiotic hits the patient's bloodstream at start-time antibiotic has been ordered; they the perfect time, just as he's being posi- should then stay in constant communica- tioned, sedated and prepped — and com- tion with the OR. From there, the circula- fortably within 1 hour of the incision time. tor can keep them updated on when the Never take for granted that medications, Ms. Reece (ca thy.reece@wellstar.org) is the manager of surgical services at WellStar Windy Hill Hospital in Marietta, Ga. case will end, so the antibiotic can be correct surgery sites and patient allergies started by the pre-op staff at the appropri- have been confirmed at the previous stop ate (earlier) time. along the surgical pathway. Be sure to On the other hand, be aware that diffi- warn patients that they'll be asked the cult intubations before the start of surgery same questions several times, and not to can delay the beginning of procedures and be concerned that your staff doesn't know negatively impact on-time antibiotic deliv- what it's doing. Tell them that you're in ery. If anesthesia providers anticipate diffi- fact double-checking the information for cult airways, have them alert the circulat- their safety. ing nurse so she can delay the medication 4 0 SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | J A N U A R Y 2013 J A N U A R Y 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 4 1