Surgical Care Improvement Project - Pharmacy Process Improvement (Software)

1. Surgical Care Improvement Project - Pharmacy Process Improvement (Software) Mark Wong, Pharm.D., BCPS1,2,3;George Melnik, Pharm.D., BCPS, 1,2 South Texas Veterans Health Care System (STVHCS)1, The University of Texas at Austin College of Pharmacy2, The University of Texas Health Science Center at San Antonio3 Interventions Results Background • Example of old antibiotic selection menu The Surgical Care Improvement Project (SCIP) is just one of the Core Measures that is reported to Joint Commission (JCAHO) and the Centers for Medicare/Medicaid services (CMS) by every institutional facility that provides surgical care. The goal of SCIP is to improve outcomes and reduce nationally the incidence of surgical complications. Not only can JCAHO decide a hospital’s accreditation on a facility’s SCIP performance compliance, but a facility’s CMS reimbursement will be affected as well. Part of the SCIP performance monitoring among other areas for surgical services is proper antibiotic selection, its timeliness prior to surgery & post-operative discontinuation, proper deep venous thromboembolism (DVT) prophylaxis after surgery, and glucose control in cardiac surgery patients. SCIP performance is emphasized due to evidence showing reduced post-operative complications and reduced length of stays. At the STVHCS, these measures were not being fully met, and improvements were needed. Table 1– SCIP Order Fallouts CPRS order interventions • Added DVT prophylaxis order menus in surgery order sets • Updated antibiotic selection menu (see example below) Objectives Conclusion/Discussion Starting back in October 2010, STVHCS began identifying what changes could be made to improve compliance. A previous attempt was made by utilizing quick-cards for the junior staff physicians, but variation still existed. Another intervention was to update the CPRS surgical order menus to make peri-operative care more standardized. Our clinical pharmacy service identified old CPRS menus as a potential target for improvement. Pharmacy personnel in collaboration with the surgeons and information technology specialists implemented these changes mid-March. CPRS changes included more specific order menus and quick orders for the surgical service for pre- and post-operative surgeries as well as a DVT prophylaxis menu for post-operative admissions. CPRS order menus periodically need to be updated. SCIP measures improved just after implementing the new order menus. In order to achieve a goal of 100% compliance, periodic education on the use of the menus is still crucial as the quick orders only work if the personnel uses them. Bibliography Bratzler DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. CID. 2004;38: 1706 Bratzler DW, Houck PE, Richards C, et al. Use of antimicrobial prophylaxis for major surgery. Archives Surgery. 2005;140:174-182 Heit JA, O’Fallon WM, Petterson TM. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism. Arch Intern Med. 2002;12:1245-1248 Zerr, KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:335-361 Contact Information: Mark Wong, Pharm.D., South Texas Veterans Health Care System 7400 Merton Minter Boulevard (119) San Antonio, Texas 78229 E-mail: mark.wong@va.gov