Release Notes:
Measure Information Form
Version 2010A1
**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**Measure Information Form
Measure Set: Surgical Care Improvement Project (SCIP)
Set Measure ID: SCIP-Inf-3
| Set Measure ID |
Performance Measure Name |
| SCIP-Inf-3a |
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time - Overall Rate |
| SCIP-Inf-3b * |
Prophylactic Antibiotics Discontinued Within 48 Hours After Surgery End Time CABG |
| SCIP-Inf-3c * |
Prophylactic Antibiotics Discontinued Within 48 Hours After Surgery End Time - Other Cardiac Surgery |
| SCIP-Inf-3d * |
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time - Hip Arthroplasty |
| SCIP-Inf-3e * |
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time - Knee Arthroplasty |
| SCIP-Inf-3f * |
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time - Colon Surgery |
| SCIP-Inf-3g * |
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time Hysterectomy |
| SCIP-Inf-3h * |
Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time - Vascular Surgery |
* Joint Commission Only
Performance Measure Name: Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time
Description: Surgical patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time. *The Society of Thoracic Surgeons (STS) Practice Guideline for Antibiotic Prophylaxis in Cardiac Surgery (2006) indicates that there is no reason to extend antibiotics beyond 48 hours for cardiac surgery and very explicitly states that antibiotics should not be extended beyond 48 hours even with tubes and drains in place for cardiac surgery.
Rationale: A goal of prophylaxis with antibiotics is to provide benefit to the patient with as little risk as possible. It is important to maintain therapeutic serum and tissue levels throughout the operation. Intraoperative re-dosing may be needed for long operations. However, administration of antibiotics for more than a few hours after the incision is closed offers no additional benefit to the surgical patient. Prolonged administration does increase the risk of Clostridium difficile infection and the development of antimicrobial resistant pathogens.
Type of Measure: Process
Improvement Noted As: Increase in the rate
Numerator Statement: Number of surgical patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time (48 hours for CABG or Other Cardiac Surgery).
Included Populations: Not applicable
Excluded Populations: None
Data Elements:
Denominator Statement: All selected surgical patients with no evidence of prior infection.
Included Populations:
- An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.10 for ICD-9-CM codes)
AND
- An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.01-5.08 for ICD-9-CM codes)
Excluded Populations:
- Patients less than 18 years of age
- Patients who have a length of Stay >120 days
- Patients who had a principal diagnosis suggestive of preoperative infectious diseases (as defined in Appendix A, Table 5.09 for ICD-9-CM codes)
- Patients whose ICD-9-CM principal procedure was performed entirely by laparoscope
- Patients enrolled in clinical trials
- Patients whose ICD-9-CM principal procedure occurred prior to the date of admission
- Patients with physician/advanced practice nurse/physician assistant (physician/APN/PA) documented infection prior to surgical procedure of interest
- Patients who had a joint revision
- Patients who expired perioperatively
- Patients who had other procedures requiring general or spinal anesthesia that occurred within three days (four days for CABG or Other Cardiac Surgery) prior to or after the procedure of interest (during separate surgical episodes) during this hospital stay
- Patients who were receiving antibiotics more than 24 hours prior to surgery (except colon surgery patients taking oral prophylactic antibiotics)
- Patients who were receiving antibiotics within 24 hours prior to arrival (except colon surgery patients taking oral prophylactic antibiotics)
- Patients who did not receive any antibiotics during this hospitalization.
- Patients who received urinary antiseptics only (as defined in Appendix C, Table 3.11)
- Patients who were diagnosed with infections within two days (three days for CABG or Other Cardiac Surgery) after Surgery End Date
Data Elements:
Continuous Variable Statement:
Included Populations:
Excluded Populations:
Data Elements:
Risk Adjustment: No.
Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective data sources for required data elements include administrative data and medical records.
Data Accuracy: Abstracted antibiotics are those administered from the time of arrival through the first 48 hours (72 hours for CABG or Other Cardiac Surgery) after the surgery end time. Refer to Appendix C, Table 2.1, which contains a complete listing of antibiotics.
Measure Analysis Suggestions: Consideration may be given to relating this measure to SCIP-Inf-1 and SCIP-Inf-2 in order to evaluate to which aspects of antibiotic prophylaxis would most benefit from an improvement effort. The process-owners of the timing of discontinuation of antibiotics subsequent to surgery include physicians/APNs/PAs, the post-surgical recovery team, as well as the postoperative nursing unit. By including the appropriate groups involved in the postoperative care process, one can more clearly ascertain where in the process the team may need to focus for improvement.
Sampling: Yes. For additional information see the Sampling Section.
Data Reported As: Aggregate rate generated from count data reported as a proportion. Overall aggregate rate for all surgeries and stratified rates by data element ICD-9-CM Principal Procedure Code, generated from count data reported as a proportion.
Selected References:
- Bratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 July):1706-1715.
- Crabtree TD, Pelletier SJ, Gleason TG, et al. Clinical characteristics and antibiotic utilization in surgical patients with Clostridium difficile_-associated diarrhea. _Am Surg. 1999;65:507-511.
- Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic prophylaxis in cardiac surgery, Part I: Duration, 2006. Ann Thoracic Surg 2006; 81: 397-404.
- Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280. http://www.ahrq.gov/clinic/ptsafety/chap20a.htm
- McDonald M, Grabsch E, Marshall C, et al. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systemic review. Aust N Z J Surg. 1988;68:388-396.
- Scher KS. Studies on the duration of antibiotic administration for surgical prophylaxis. Am Surg. 1997;63:59-62.
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