Skip to main content
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2004 Oct;13(5):384–387. doi: 10.1136/qshc.2003.009696

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

S Ritchie 1, N Scanlon 1, M Lewis 1, P Black 1
PMCID: PMC1743887  PMID: 15465943

Abstract



Problem: Antibiotic prophylaxis has been shown to reduce the number of postoperative infections following surgery for hip fracture. At Auckland Hospital the policy for antibiotic prophylaxis for hip fracture surgery is for the patient to receive the first dose of antibiotic at the induction of anaesthesia followed by two more doses at 8 hour intervals. A previous audit found that patients often received too many doses of antibiotic. A retrospective audit was performed of 100 patients undergoing surgery for a hip fracture. The primary problem was over-prescribing; 68 patients (68%) received more than three doses. The number of patients who received three doses according to the guidelines was 29 (29%, 95% CI 21 to 40).

Setting: Auckland Hospital which provides acute orthopaedic services for a population of 500 000.

Strategy for change: A sticker was introduced with the prescription printed on it. The sticker was applied to the medication chart by the anaesthetist when the initial dose of antibiotic was given. Charts of a further 100 patients were reviewed after the introduction of the sticker and compared with those from another hospital in Auckland where the sticker was not used.

Effects of change: The number of patients who received three doses, in accordance with the guidelines, improved to 74 (74%, 95% CI 64 to 82, p<0.001). These changes were observed even though the sticker was only used in 44 patients (44%, 95% CI 34 to 54). At the other hospital the number of patients who received three doses was 10 (20%, 95% CI 10 to 42) and 13 (26%, 95% CI 15 to 40, p = 0.37) for the same two periods.

Lessons learnt: The use of a preprinted sticker is a simple intervention which improves the use of antibiotic prophylaxis at the time of surgery. This improvement occurred even though the sticker was used in slightly fewer than half the cases.

Full Text

The Full Text of this article is available as a PDF (80.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boxma H., Broekhuizen T., Patka P., Oosting H. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet. 1996 Apr 27;347(9009):1133–1137. doi: 10.1016/s0140-6736(96)90606-6. [DOI] [PubMed] [Google Scholar]
  2. Burnett J. W., Gustilo R. B., Williams D. N., Kind A. C. Prophylactic antibiotics in hip fractures. A double-blind, prospective study. J Bone Joint Surg Am. 1980 Apr;62(3):457–462. [PubMed] [Google Scholar]
  3. Classen D. C., Evans R. S., Pestotnik S. L., Horn S. D., Menlove R. L., Burke J. P. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992 Jan 30;326(5):281–286. doi: 10.1056/NEJM199201303260501. [DOI] [PubMed] [Google Scholar]
  4. Gyssens I. C., Geerligs I. E., Dony J. M., van der Vliet J. A., van Kampen A., van den Broek P. J., Hekster Y. A., van der Meer J. W. Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital. J Antimicrob Chemother. 1996 Dec;38(6):1001–1012. doi: 10.1093/jac/38.6.1001. [DOI] [PubMed] [Google Scholar]
  5. Kernodle D. S., Barg N. L., Kaiser A. B. Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis. Antimicrob Agents Chemother. 1988 Feb;32(2):202–208. doi: 10.1128/aac.32.2.202. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES