The team members received the award for their efforts to put processes in place to help prevent surgical site infections.

“We decided to develop a Perioperative Antibiotic Order Sheet that would have the recommended antibiotics listed by types of surgery,” says Yvonne Acker, a performance improvement nurse. “However, we had members of the team that had seen previous attempts at developing antibiotic order sheets fail because there was no process in place to ensure that they were used consistently.”

The team realized that the only way to be successful was to make the order sheet mandatory. They sent letters to surgeons, made presentations, ensured that order sheets were available, and worked with pharmacists, nurses and anesthetists to ensure the sheets were being used. Their efforts paid off: the Perioperative Antibiotic Order Sheet was introduced in January 2006 with a deadline of May 2006 for mandatory usage. Since May, compliance has been at or near 100 percent.

Thomas Marsicano, M.D., a cardiothoracic surgeon and the physician champion for the team, is encouraged by these results.

“I have participated in many committees over the last 18 years but results such as what were achieved here are not all that common,” he says. “It takes great patience to bring all the different participants together and convince them that a common goal is worth while. The hospital deserves a great deal of credit in providing the structure to achieve this, and I was pleased that our medical staff confirmed my confidence that they would step up and demonstrate their continued commitment to quality.”

Continuing Teamwork

“When our group first started meeting, there was some skepticism about our ability to implement change with processes that had been in place for a long time,” says Acker. “But our success with the antibiotic order sheet has given us courage to know that we can continue to take on future challenges in providing the best surgical care possible. We know that if we work together as a team, we can figure out creative ways to meet and exceed our goals.”

In addition to the antibiotic order sheet project, the team has also identified other opportunities for improvement in hospital processes that will improve care for surgery patients. These include:

• Developing a Normothermia Policy for colorectal surgery patients to help maintain normal body temperature during the perioperative period
• Developing a Clipping Policy to ensure that patients that need hair removed from the surgical site are not shaved, but clipped, to avoid possible skin damage
• Developing a Cardiac Surgery Insulin Protocol  to assist with glucose control in cardiac surgery patients
• Implementing consistent Venous Thromboembolism (VTE) prophylaxis in surgery patients according to national guidelines to reduce bloodclots
• Developing strategies to ensure that surgical patients are assessed for cardiac risk factors before surgery and placed on appropriate heart protection medication when indicated

“The fact that this team managed to bring medicine, nursing and management to one table with a goal to make the necessary changes for best practice models and implement these changes in an organized manner has proven a best practice for committee structure,” says Ruth Long, a certified registered nurse anesthetist on the team.

For Lambros, the creativity of the team is what keeps it going. “I think what I am most proud of is how the team engages itself in the directives,” she says. “They do not just look at what the initiatives require but what is in the best interest of our patients. The team is so diverse that we are able to foresee potential problems with the implementation of certain programs and decide on a strategy to overcome those obstacles and then formulate a plan for implementation. That’s the way it should be.”