Service evaluation exploring causes of delayed metronidazole intravenous administration in surgeries requiring dual preoperative antibiotic use for surgical prophylaxis

O'Byrne, Rose-Marie; El Gendy, Amany

Abstract

Introduction

Adherence to surgical prophylaxis guidelines is important for preventing infections, reducing costs, and preventing antimicrobial resistance. (Darouiche, 2019) Misuse or overuse of antibiotics can lead to future infections. Fluctuating results of compliance with the timing of administration of these antibiotics required an investigation to find factors causing the delays and finding solutions to improve compliance.



- Aim

Identify factors that contributed to noncompliance with the time of administration of metronidazole before surgeries and find solutions.



-Methods

Ethical approval was not required for this quantitative project as it was a service evaluation. A questionnaire form was developed using Google Forms to address the aim of the study and sent via email to staff involved in preoperative antibiotic ordering, order verification, medication preparation, and medication administration. Responses were collected from 7th November 2023 to 2nd January 2024. Data was analysed using descriptive statistical analysis of quantitative data using Pie charts, bar methods, and cross-tabulation using SPSS® software.

-Results

The survey was completed by 99 respondents out of the 132 persons who received the questionnaire (75%).

46.5% of respondents identified late ordering as the main reason for delayed metronidazole administration before surgeries. The reasons for late ordering were attributed to overwhelmed physicians, work overload, and lack of time in emergency cases, poor communication between doctors, and poor communication between pharmacists and nurses. The other reasons for delayed administration were late order verification (26.3%) and late IV administration (27.3%) due to difficulty of simultaneous administration of metronidazole with cefazolin.

To improve compliance with the guidelines, 51% of the respondents preferred to unify the location of Cefazolin and Metronidazole for surgical prophylaxis in the operation theatre, and 42% of respondents preferred to re-educate staff on the proper application of the surgical prophylaxis guidelines.

44.4% of respondents preferred infusing cefazolin and metronidazole at the Y site. However, the results identified that nurses are hesitant to infuse both antibiotics together. Another option to infuse metronidazole over 30 minutes was chosen by 41.4% of the respondents.



-Discussion/Conclusions

. Despite this study being limited to a small sample size, the findings identified the main reported cause of delayed administration of Metronidazole before surgeries is late ordering due to overwhelmed prescribers and emergency cases. Pharmacy issues included overwhelmed pharmacists and poor communication. Strategies to alleviate workload could include staffing optimization, process improvement, enhanced communication, and training. Another finding was that nurses struggled with infusing two antibiotics simultaneously. Administering both antibiotics via Y- site might be a good solution to prevent administration delay (Micromedex, 2024) once the order has been placed. Further evaluation could incorporate qualitative elements such as interviews or open-ended questions into the questionnaire to get ideas of potential solutions from staff.

Citation

O'Byrne, R.-M., & El Gendy, A. (2024, November). Service evaluation exploring causes of delayed metronidazole intravenous administration in surgeries requiring dual preoperative antibiotic use for surgical prophylaxis. Poster presented at Royal Pharmaceutical Society Conference, London, UK

• Presentation Conference Type: Poster
• Conference Name: Royal Pharmaceutical Society Conference
• Conference Location: London, UK
• Start Date: Nov 8, 2024
• End Date: Nov 8, 2024
• Deposit Date: Mar 24, 2025
• Keywords: Delayed, Administration, Metronidazole, Surgical, Prophylaxis
• Public URL: https://keele-repository.worktribe.com/output/1110912