Evaluating the implementability of Antibiotic Surgical Prophylaxis guidelines

Courtney Ierano; Darshini Ayton; Trisha Peel; Caroline Marshall; Karin Thursky

doi:10.1016/j.idh.2019.08.004

Evaluating the implementability of Antibiotic Surgical Prophylaxis guidelines

Infect Dis Health. 2020 Feb;25(1):11-21. doi: 10.1016/j.idh.2019.08.004. Epub 2019 Sep 12.

Authors

Courtney Ierano¹, Darshini Ayton², Trisha Peel³, Caroline Marshall⁴, Karin Thursky⁵

Affiliations

¹ National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia. Electronic address: cierano@student.unimelb.edu.au.
² Monash University, Department of Epidemiology and Preventive Medicine, 553 St Kilda Road, Melbourne, VIC, Australia.
³ National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, VIC, Australia.
⁴ National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC, Australia; Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, VIC, Australia.
⁵ National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.

PMID: 31523036
DOI: 10.1016/j.idh.2019.08.004

Abstract

Background: Current Australian data highlight guideline noncompliant prescribing of antimicrobials for surgical prophylaxis. The study aim was to evaluate the implementability of the Australian national surgical prophylaxis (SAP) guidelines to identify facilitators for and barriers to compliance.

Methods: Key stakeholders appraised the surgical prophylaxis guidelines using the GuideLine Implementability Appraisal (GLIA) tool. Questions with 100% agreement for the response 'Yes' were identified as facilitators and those with 100% agreement for 'No', a barrier. Questions that did not receive 100% agreement, but had a majority (40-60%) 'Yes' or 'No' consensus were considered as borderline facilitators and barriers respectively.

Results: Ten appraisals were completed. Guideline recommendations were rated as easily identifiable and concise and were thus facilitators for implementation. The ability to measure guideline adherence and outcomes, and recommendations that were consistent with guideline user abilities and beliefs were also identified as facilitators. Borderline facilitators related to the clarity of the recommendations and whether they were explicit in what to do and in what circumstances. Evidence quality underpinning recommendations (validity), inflexibility of recommendations (flexibility) and the lack of patient data at the point of use (computability) were identified as borderline barriers to implementation. No recommendation reached agreement as being a barrier.

Conclusion: The GLIA appraisal demonstrated overall implementability of the current Australian national surgical prophylaxis guidelines. Facilitators (i.e., measurability) and borderline facilitators highlight strengths of the current guideline. Borderline barriers (i.e., validity, flexibility and computability) may negatively impact upon implementability. Guideline developers should consider these dimensions to optimise guideline uptake and consequently patient care.

Keywords: Guideline compliance; Guideline implementability; Surgical antimicrobial prophylaxis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / administration & dosage
Anti-Bacterial Agents / therapeutic use*
Antibiotic Prophylaxis*
Australia
Clinical Audit
Guideline Adherence
Health Plan Implementation*
Humans
Practice Guidelines as Topic*
Surgical Wound Infection / prevention & control*

Substances

Anti-Bacterial Agents