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. 2019 Jun 21;9(6):e029671.
doi: 10.1136/bmjopen-2019-029671.

Investigation of perioperative work processes in provision of antibiotic prophylaxis: a prospective descriptive qualitative study across surgical specialties in Norway

Hilde Valen Wæhle  1   2 , Stig Harthug  1   2 , Eirik Søfteland  3   4 , Nick Sevdalis  5 , Ingrid Smith  6 , Siri Wiig  7 , Karina Aase  7 , Arvid Steinar Haugen  3
Affiliations

Investigation of perioperative work processes in provision of antibiotic prophylaxis: a prospective descriptive qualitative study across surgical specialties in Norway

Hilde Valen Wæhle et al. BMJ Open. .

Abstract

Objective: Surgical site infections are known postoperative complications, yet the most preventable of healthcare-associated infections. Correct provision of surgical antibiotic prophylaxis (SAP) is crucial. Use of the WHO Safe Surgical Checklist (SSC) has been reported to improve provision of SAP, and reduce infections postoperatively. To understand possible mechanisms and interactions generating such effects, we explored the underlying work processes of SAP provision and SSC performance at the intersection of perioperative procedures and actual team working.

Design: An ethnographic study including observations and in-depth interviews. A combination of deductive and inductive content analysis of the data was conducted.

Setting: Operating theatres with different surgical specialities, in three Norwegian hospitals.

Participants: Observations of perioperative team working (40 hours) and in-depth interviews of 19 experienced perioperative team members were conducted. Interview participants followed a maximum variation purposive sampling strategy.

Results: Analysis identified provision of SAP as a process of linked activities; sequenced, yet disconnected in time and space throughout the perioperative phase. Provision of SAP was handled in relation to several interactive factors: preparation and administration, prescription accuracy, diversity of prescription order systems, patient-specific conditions and changes in operating theatre schedules. However, prescription checks were performed either as formal SSC reviews of SAP items or as informal checks of relevant documents. In addition, use of cognitive reminders and clinical experiences were identified as mechanisms used to enable administration of SAP within the 60 min timeframe described in the SSC.

Conclusion: Provision of SAP was identified as a complex process. Yet, a key element in provision of SAP was the given 60 min. timeframe of administration before incision, provided in the SSC. Thus, the SSC seems beneficial in supporting timely SAP administration practice by either being a cognitive tool and/or as a cognitive intervention.

Keywords: antibiotic prophylaxis; patient safety; preoperative care; qualitative research; surgical wound infection.

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Conflict of interest statement

Competing interests: NS is the Director of London Safety and Training Solutions Ltd, which provides quality and safety training and advisory services on a consultancy basis to healthcare organisation globally.

Figures

Figure 1
Figure 1
The clinical pathway of surgical antibiotic prophylaxis (SAP): an outline of the workflow for SAP in perioperative care.
See this image and copyright information in PMC

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