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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Perioperative care: percentage of surgical patients aged 18 years and older who have an order for a parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required) for whom administration of a prophylactic antibiotic has been initiated within one hour (if vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required).
Source(s)
American College of Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Perioperative care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2006 Oct. 11 p. [8 references]

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to assess the percentage of surgical patients aged 18 years and older who have an order for a parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required) for whom administration of a prophylactic antibiotic has been initiated within one hour (if vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required).

Rationale

The appropriate timing of administration of prophylactic antibiotics has been demonstrated to reduce the incidence of surgical wound infections. Available evidence suggests that although most surgical patients receive a prophylactic antibiotic, many do not receive the drug within one hour before incision as recommended.*

*The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

The anti-infective drug should ideally be given within 30 minutes to 1 hour before the initial incision to ensure its presence in an adequate concentration in the targeted tissues. For most procedures, scheduling administration at the time of induction of anesthesia ensures adequate concentrations during the period of potential contamination. Exceptions: cesarean procedures (after cross clamping of the umbilical cord); colonic procedures (starting 19 hours before the scheduled time of surgery). (American Society of Health-System Pharmacists [ASHP])

Infusion of the first antimicrobial dose should begin within 60 min before incision. However, when a fluoroquinolone or vancomycin is indicated, the infusion should begin within 120 min before incision to prevent antibiotic-associated reactions. Although research has demonstrated that administration of the antimicrobial at the time of anesthesia induction is safe and results in adequate serum and tissue drug levels at the time of incision, there was no consensus that the infusion must be completed before incision. (Surgical Infection Prevention Guidelines Writers Workgroup [SIPGWW])

Evidence for Rationale
American College of Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Perioperative care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2006 Oct. 11 p. [8 references]

American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm. 1999 Sep 15;56(18):1839-88. [559 references] PubMed External Web Site Policy

Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, American Academy of Orthopaedic Surgeons, American Association of Critical Care Nurses, American Association of Nurse Anesthetists, American College of Surgeons, American College of Osteopathic Surgeons, American Geriatrics Society, American Society of Anesthesiologists, American Society of Colon and Rectal Surgeons, American Society of Health-System Pharmacists, American Society of PeriAnesthesia Nurses, Ascension Health, Association of periOperative Registered Nurses, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Medical Letter, Premier, Society for Healthcare Epidemiology of America, Society of Thoracic Surgeons, Surgical Infection Society. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004 Jun 15;38(12):1706-15. [90 references] PubMed External Web Site Policy
Primary Health Components

Perioperative care; timing of prophylactic parental antibiotics

Denominator Description

All surgical patients aged 18 years and older who have an order for a parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Surgical patients for whom administration of a prophylactic antibiotic has been initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use of the Measure

State of Use
Current routine use
Current Use
Internal quality improvement
Pay-for-reporting
Professional certification
Public reporting

Application of the Measure in its Current Use

Measurement Setting
Hospital Inpatient
Professionals Involved in Delivery of Health Services
Physicians
Least Aggregated Level of Services Delivery Addressed
Individual Clinicians or Public Health Professionals
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Age

Age greater than or equal to 18 years

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness
Timeliness

Data Collection for the Measure

Case Finding Period

Unspecified

Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Patient/Individual (Consumer) Characteristic
Therapeutic Intervention
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions

Inclusions
All surgical patients aged 18 years and older who have an order for a parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)

Note: There must be documentation of order (written order, verbal order, or standing order/protocol) specifying that antibiotic is to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required).

Exclusions
None

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
Surgical patients for whom administration of a prophylactic antibiotic has been initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)

Exclusions
None

Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Electronic health/medical record
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

Unspecified

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison

Identifying Information

Original Title

Measure #2: timing of prophylactic antibiotics - administering physician.

Submitter
American Medical Association on behalf of the American College of Surgeons, Physician Consortium for Performance Improvement®, and National Committee for Quality Assurance - Medical Specialty Society
Developer
American College of Surgeons - Medical Specialty Society
National Committee for Quality Assurance - Health Care Accreditation Organization
Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration
Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Ronald A. Gabel, MD (Co-Chair); R. Scott Jones, MD, FACS (Co-Chair); Priscilla Arnold, MD; Raj Behal, MD, MPH; Dale W. Bratzler, DO, MPH; Quentin Clemens, MD; Charles Drueck, MD, FACC; Fred Edwards, MD; Lee A. Fleisher, MD, FACC; Alex Hannenberg, MD; Daniel L. Herr, MS, MD, FCCM; David Hunt, MD, FACS; Kay Jewell, MD; Rahul K. Khare, MD, FACS; Shukri F. Khuri, MD, MBA; Rick Leary, MD, MBA; Kenneth Moore, MD; Mark Morasch, MD; Stephen Novack, DO; Frank Opelka, MD; Laura Orvidas, MD; Tom Read, MD; Sam J.W. Romeo, MD, MBA; Jerry Shuster, MD; Carl A. Sirio, MD; Sandra Tunajek, CRNA, ND; Patrick Voight, RN, BSN, MSA, CNOR; William Wooden, MD

Julie Lewis, American College of Surgeons; Karen Richards, American College of Surgeons

Mark S. Antman, DDS, MBA, American Medical Association; Karen S. Kmetik, PhD, American Medical Association; Beth Tapper, MA, American Medical Association; Samantha Tierney, MPH, American Medical Association

Joachim Roski, PhD, MPH, National Committee for Quality Assurance

Tom Croghan, MD; Latousha Leslie, RN, MS, Mathematica Policy Research, Centers for Medicare & Medicaid Services; Sylvia Publ, MBA, RHIA, Mathematica Policy Research, Centers for Medicare & Medicaid Services; Michael Rapp, MD, Mathematica Policy Research, Centers for Medicare & Medicaid Services

Lisa Buczkowski, RN, MS, Joint Commission on Accreditation of Healthcare Organizations; Raquel Gabriel-Bennewitz, MS/MBA, BSN, RN, Joint Commission on Accreditation of Healthcare Organizations

Rebecca A. Kresowik, Facilitators; Timothy F. Kresowik, MD, Facilitator

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Endorser
National Quality Forum
NQF Number
0269
Date of Endorsement

2007 Nov 15

Measure Initiative(s)
Physician Quality Reporting System
Adaptation

This measure was harmonized to the extent possible to measures included in the Surgical Care Improvement Project (SCIP).

Date of Most Current Version in NQMC
2006 Oct
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The Physician Consortium for Performance Improvement reaffirmed the currency of this measure in November 2011.

Source(s)
American College of Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Perioperative care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2006 Oct. 11 p. [8 references]
Measure Availability

The individual measure, "Measure #2: Timing of Prophylactic Antibiotics - Administering Physician," is published in the "Perioperative Care Physician Performance Measurement Set." This document and technical specifications are available in Portable Document Format (PDF) from the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® Web site: www.physicianconsortium.org External Web Site Policy.

For further information, please contact AMA staff by e-mail at cqi@ama-assn.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on September 13, 2007. The information was verified by the measure developer on October 26, 2007. This NQMC summary was retrofitted into the new template on June 8, 2011. The information was reaffirmed by the measure developer on November 30, 2011.

Copyright Statement

© Measures including specifications

© 2005-6 American Medical Association and National Committee for Quality Assurance

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