This presentation described features of a custom OR information system used to ensure timely administration of the correct antibiotics prior to surgery. The custom software (John Galt Systems) has since been replaced by an off-the-shelf product (Epic).

1. 2010 Surgical Services
Informatics
Improvement #1:
New Surgical Services
Prophylactic Antibiotic
Protocol for WFUBMC
JC Gerancher MD
Medical Director of
Surgical Services
Informatics

2. Why we have an Institutional Prophylactic
Antibiotic Protocol
• All OR personnel share responsibility for decreasing
surgical site infections. In addition, we all have
responsibility in controlling the proliferation of
resistant organisms from unnecessary antibiotic use.
• Choice and Timing of antibiotics used for surgical
prophylaxis are part of quality measures under
scrutiny by regulatory agencies.
• Documentation of compliance required by these
agencies while choosing and timing the best
antibiotic(s) is a complex undertaking.

3. CAUSE = Center for Antibiotic Utilization,
Stewardship, & Epidemiology
• This WFUBMC organization is charged with guiding
antibiotic choice and timing to best practice based on
evidence based medicine, national guidelines, and
local patterns of antibiotic susceptibility.
• CAUSE has developed and will maintain a process
and database to encourage the choice of best
practice for prophylactic antibiotics.
• The Operating Room Information System (ORIS)
John Galt will be used to help guide users toward
choosing the best antibiotic at the correct time for
every patient cared for in the WFUBMC operating
room.

4. Overview of the new institutional protocol for
administration of Antibiotics
• The existing “antibiotic page” in JG Anesthesia will be
updated and expanded to Holding, Regional, Anesthesia,
and PACU applications.
• This page is much smarter and more informative than the
current one.
• It ‘autofills’ choice and dose based on age, weight, and all
3000 types of surgical procedures we do.
• A ‘re-dose’ timer will follow each patient from Holding to
PACU so that a re-dose reminder will ‘pop-up’.
• Over-ride of CAUSE recommendations is possible but
highly discouraged because it will likely result in patient
care outside of compliance with best practice.

5. This is the appearance of the
new page in JGAnesthesia
….and often no antibiotic
is the correct antibiotic:

6. This is the appearance of the
new view in JGHolding,
Regional, and PACU.

7. A link to antibiotics is present on the first page of
each application.
Completion of the antibiotic page
is required before creating an EMR.
Completion of the antibiotic screen
turns the link from red to green.
RN’s in Holding and Regional will
not be expected to initiate
antibiotics without MD input.
Anesthesia providers will be
expected to initiative recommended
antibiotics and re-doses unless
directed not to do so by a member
of the surgical team.
Charting of all antibiotics should be
through this new page only.
Use of recommended antibiotic can
be documented with one button
click. Please do not free text.

8. All applications work off a large database table
• The table was created by CAUSE.
• It will be updated by CAUSE and ORIS.
• Antibiotics are based on anatomic location and best practices
rather than the preferences of individual clinicians.

9. All applications now require an age and weight for
the antibiotic program to function
Weight and age are necessary for the new antibiotic applications to open.
Age is populated at registration. Weight is now required to be documented as early as possible.
Weight is a tightly controlled piece of data updated and
shared between all John Galt applications through
database linkages.
Weight will auto-fill into your application only after these three things have happened :
1. Your patient’s case code is opened in any John Galt application (Intake, Holding, Regional, Anesthesia,
PACU).
2. A weight was entered sometime in the past.
3. Your patient’s case code is then closed in this application at some time before you open yours.
If these three things have not happened at some point before you open your application, you will be
prompted to enter a weight.
An estimated weight can be entered in an
emergency situation or when the previous
application remains open. Multiple ‘error
messages’ will prevent proceeding without
documentation of a weight. Complete charting
and creation of a medical record requires a
weight to be documented.

10. Prophylactic antibiotic administration is tightly tied
to incision time.
Anesthesia providers have ‘ownership’ of
incision time.
What you enter on the antibiotic page will
auto-fill your record on page one and be
the incision time in the EMR.
Prompts will encourage documentation of
antibiotic administration within 60 minutes
of incision time.
Selection of one check box will document
with one click the recommended, severe
PCN allergic, MRSA, or MRSA+PCN
allergic antibiotic (s).
The dose, route, and updated redose
time will be documented as well.
Adjustment of dose for neonates and
pediatric weight will be made.

11. The new antibiotic application has a redose timer
• You will be prompted to re-dose antibiotic(s).
• Choose “now “or “in ten minutes”.
• Re-dosing times are based on the shorter times correct for intra-op use.
• The re-dose timer “follows” the patient across applications for the peri-operative
period.
• Documentation is accomplished with a single click for recommended
antibiotics.
• Re-dosing non-recommended antibiotics is not prompted and requires
manual entry.

12. Questions or comments:
• Questions or concerns regarding particular CAUSE
antibiotics may be referred to Dr Chris Ohl (of
CAUSE)
• Questions or concerns about the software may be
referred to Dr JC Gerancher or Tammy Brown (of
Surgical Services Informatics).
• Questions in real time from users may be referred to
ORIS at 6-3661
• User documents, instructions, and discussions are
available at: http://sp4.wfubmc.edu/sites/oris