Antibiotic stewardship in the surgical patient: implementing an evidenced-based algorithm to decrease administration of broad-spectrum antibiotics in patients with a documented beta-lactam allergy
Creators: name: Jernick, Brian
Publisher: name: No Publisher Supplied
Year: 2023

description: Purpose of Project: Quality improvement project aimed to improve antibiotic stewardship in the surgical patient. Key stakeholders within the anesthesia, surgical, and nursing departments were educated on the use of the PEN-FAST screening tool built into the electronic medical records (EMR). Objectives of the study were to improve the appropriate administration of antibiotics for patients who self-report a non- IgE mediated penicillin allergy, reduce rates of surgical site infections (SSI) and antibiotic resistant organisms, and see an overall improvement in post-operative patient outcomes. Methodology: A retrospective chart review of 50 adult, non-obstetrical, surgical patients with a documented beta-lactam allergy was performed to determine whether the utilization of an approved antimicrobial algorithm decreased administration rates of broad-spectrum antibiotics in patients with a documented penicillin allergy. Investigators enrolled 20% of the patients (n=50) who self-report a penicillin allergy within the 16-week study period. Inclusion criteria: Adult, non-obstetrical, surgical patients with a documented beta-lactam allergy undergoing procedures in the main operating room. Exclusion criteria: Pediatric patients, those who have a documented or reported IgE-mediated reaction to beta-lactam antibiotics, those with a history of blistering disorders (ie. steven Johnson's syndrome), hemolytic anemia, nephritis, and hypersensitivity vasculitis. Results: Out of 153 surgical patients from September through December of 2021, 50 patients were selected based on inclusion and exclusion criteria as pre-implementation data. After implementation of the PEN-FAST screening tool, a total of 50 patients were selected to determine if surgical patients with a documented non-IgE mediated beta-lactam allergy received the appropriate prophylactic surgical antibiotic. To determine the linear relationship between the two variables, a paired t-test and a Pearson correlation test were performed to determine if implementation of the PEN-FAST screening tool had a relationship with the type of antibiotic administered to the surgical patient with a documented non-IgE mediated beta-lactam allergy. The p-value to determine a statistical significance was set to 0.05 or less. Post-implementation data showed that eighty percent (n=40, p &lt;0.001) of patients with a beta-lactam allergy were in fact administered a cephalosporin after utilizing the PEN-FAST screening tool. Twenty percent (n=10, p &lt;0.001) of patients were administered broad-spectrum antibiotics despite using the PEN-FAST tool. Pearson correlation tests also show statistical significance (p &lt;0.001) between scores from the PEN-FAST screening tool and administration of cephalosporins, thus decrease rates of administration of broad-spectrum antibiotics. Implications: Implications of this study included appropriate selection of antibiotics for the surgical patient who has a documented Penicillin allergy with the intention of improving quality of care and patient outcomes. Potential expansion of the study to other medical centers has been proposed by several key stakeholders.