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photo of William Wilson, PharmDA quality improvement effort led by CASP’s Bill Wilson, PharmD, was recognized by UNC Medical Center Improvement Council’s Quality and Safety Awards with an honorable mention for their work to prevent surgical site infections in the Children’s Hospital Operating Room.

“In the past, many patients did not have orders for perioperative antibiotics placed until they arrived the day of surgery, resulting in delayed antibiotic administration, which could increase risk of surgical site infections,” explained Wilson. Timely, standardized antibiotic administration before surgery is one way to reduce the risk of surgical site infections (SSIs).

Wilson knew changing the process would require a team approach. He convened an interdisciplinary group to help ensure that every patient undergoing a procedure in the Children’s OR who requires perioperative antibiotics receives the right antibiotic, at the right dose, at the right time. The group includes Annemarie Funt, MSN, RN; Dan Kirgesner, PharmD; Mike Phillips, MD; Sara Pittenger, MD; Emily Torgerson; Ali Ward, PharmD; and Zach Willis, MD, MPH.

The group’s initial step was to make clear each staff member’s role in the perioperative antibiotic process. Then, they continuously audited and improved workflows based on data collated from Pharmacy Data Analytics and Outcomes. Team members regularly conducted root cause analyses when antibiotic ordering departed from the order set, to troubleshoot how processes might be improved further. Together, these interventions targeted optimizing the processes of antibiotic ordering, dispensing, preparing, and administrating.

antibiotic orders were placed before the day of surgey 45% of the time in August 2020, compared to 75% of the time in Sept 2021Wilson acknowledged, “New processes need time to supplant old ways. At its core, this is about shifting our habits in the Children’s OR, and habits change slowly over time.” Even so, the group’s work has brought about impressive improvement since July 2020: an increase from 45% to 75% of antibiotic orders placed before the day of surgery. Wilson and the team say the increase is a meaningful achievement.

The group improved collaboration and transparency among team members, both necessities in quality and safety work. Their work is exemplary because of its proactive approach in identifying areas for improvement rather than reacting to adverse events. “Each of us holds one another accountable in our mission to advance patient safety,” Wilson said.

The team’s work continues as it hopes to bring about lasting change that improves the health and well-being of North Carolina’s children.