Blue Ribbon Abstract Award: Applying Six Sigma Methodology for Process Improvement of Antibiotic Timing and Antibiotic Choice in the Preoperative Patient

ISSUE: The National Surgical Infection Prevention (NSIP) Project provides quality improvement tools and measures to improve surgical patient safety. Measures include antibiotic administration within 1 hour of incision and appropriate antibiotic choice. MBHS historical data revealed 37% compliance with surgical prophylactic antibiotic timing and 67% compliance with correct antibiotic selection. PROJECT: We formed an Antibiotic Timing and Antibiotic Choice in Surgery (ATACS) team utilizing Six Sigma methodology: Define, Measure, Analyze, Improve, and Control. The teamʹs objectives were to improve antibiotic delivery from 37% to 90%, targeting administration time of 30 minutes prior to incision, and to improve prophylactic antibiotic selection compliance from 67% to 95% by June 1, 2003. The multidisciplinary team completed a cause-and-effect diagram and a Failure Mode and Effects Analysis (FMEA), and developed concise data-collection tools generating histograms, dot plots, and box plots. The team implemented a HANG & HOLD intervention and combined pre-operative order forms into one staff/physician/patient friendly Preoperative Information and Order Form. RESULTS: Antibiotic timing compliance improved 162%, from 37% (Mean=71, SD=34, N=64) to 97% (Mean=27, SD=11, N=87) (p=0.000). Compliance with correct antibiotic improved 45% from 67% (36/52) to 97% (82/84) (p=0.000). Preventing process failure was demonstrated by decreased FMEA risk scores. LESSONS LEARNED: Six Sigma methodology provided a quick study for rapid improvement. A carefully planned data-collection tool and accurate data analysis provided a basis for the teamʹs change intervention and long-term controls. A legible pre-printed pre-operative order form guiding surgeon antibiotic choice (utilizing TALL MAN lettering) supported patient safety.