Preoperative antibiotics & medication safety

[staceyp413]

Can all of my Surgical Services colleagues assist in the following questions:

May I ask each of you the process of antibiotic administration for patients going to the OR?

-Who is responsible to get them or how do they get to your unit for each case?

-Where are they kept?

-Who connects the ax bag with the tubing? The tubing to the patient?

-Generally time they are started?

-Who usually starts them

Thank you,

Stacey

[Mr. & Mrs. RN]

PACU gets the antibiotics and primes tubing. Circ connects tubing and starts. Some PACU nurses connect tubing. It is stored on the patient's cot or in their designated bin in Pre-op. Circ starts in pre-op before transporting to the OR. If it's Vanco, pre-op starts since you get 2 hours from the start of atbx to incision time. Regardless of who does what, the key is start the antibiotic before incision time and no later than 1 hour from incision.

[Rose_Queen, BSN, MSN, RN]

Depends on elective surgery vs add on case, time of day, and type of antibiotic. Vanco is to be started minimum of 60 minutes prior to OR time, and is the responsiblity of preop. Meds such as cefotetan may be mixed and primed but not hung before OR nurse gets patient in preop, who then starts it. Cefazolin is in a syringe, and is pushed either by circulator or anesthesia as patient is rolling out of preop. The more common meds (flagyl, levaquin, vanco, cefazolin, cefotetan) are kept in the preop pyxis in our standard dosages (500 mg, 1g) but anything else (med or dose) has to be ordered from pharmacy.

Elective cases or add ons during day shift usually are taken care of by preop nurses. After hours, the OR preops their own patients. Emergency cases may not get antibiotics until after incision depending on how critical/if it's already on the floor. If the surgeon wants to do cultures, usually anesthesia starts the antibiotic once they're taken.

Our policy is that antibiotics must be infused within one hour before incision, so something that needs to run for an hour (vanco) needs started earlier than something we can push in less than a minute (ancef).

[LAM2010, BSN]

In my OR, the CRNA gets the antibiotic, hooks it up, and administers it (for same-day surgeries or inpatient). I believe it's kept in the PACU area. As the circulator I verify which one the surgeon ordered, if it's available, and I chart what and when it was given (and of course, that it was given within an hour of incision, as a core measure) in the nurses' notes. If it is an inpatient I check the MAR to see if they've gotten one on the floor in the right timeframe. The IVs are inserted by the nurses who check the patients into the same-day surgery area, or by the CRNA.

[PetiteOpRN]

-Who is responsible to get them or how do they get to your unit for each case?

MD writes the order. Sometimes the preop nurse gets/hangs them, sometimes anesthesia does it. If all else fails, the circulato rwill run and get them right before wheeling back. If it is an inpatient on scheduled antibiotics, they usually have something that was just hung before coming down.

-Where are they kept?

In the pyxis We can get antibiotics in preop or the main OR pyxis, which is more convenient if we need to redose.

-Who connects the ax bag with the tubing? The tubing to the patient?

That is anesthesia's responsibility. They can delegate, as needed, but anesthesia administers all perioperative meds.

-Generally time they are started?

Between 60 minutes and 1 minute prior to the incision.

-Who usually starts them

Anesthesia