ERAS Collaborative Monthly Report
Site Name
Site Team Lead
Month Reported
Aim
BC General Hospital
Mr. ERAS
April 2015
Improve compliance with the ERAS protocols to 80% for all patients undergoing
colorectal surgery at BC General Hospital by November 1, 2015.
Measures (delete or add additional rows as needed)
% of patients who received pre-admission counseling
% of patients with no MBP or MBP + oral abx
% of patients received abx prophylaxis
% of patients received abx redosing if OR>4hours
% of patients given carbohydrate beverage
% of patients arriving in PAR with normal body temp (36-38C)
% of patients chewing gum on POD0 or POD1
Have
graph
50% to
Goal
Goal
Met
Goal
Met &
Held
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
What we learned from tests of change this month (PDSA summary)
1) Making patient education booklets available at the surgeons’ offices significantly improved rate of patients
receiving pre-admission counseling. We have also engaged 5 family physicians who will help to optimize
patients prior to surgery.
2) Education sessions with surgeons are not changing usage of MBP. Have decided to follow up with some
surgeons to better understand their practice decisions.
3) Redosing for OR more than 4 hours. Staff asked to remind anesthesia and surgeon about redosing when
handing the second anesthesia record. Several questions asked by anesthesia and surgeons about the need to
redoes. Literature given to the nurses about recommended dosing on antibiotics.
4) Appropriate antibiotics – looking more closely at antibiotics. There have been some backorder issues this
month which has influenced the choice of antibiotic. We are seeing unasyn used for colon surgery and
timentin for gastric bypass. We have developed a document to present to the surgeons with recommended
antibiotics that will be presented at their meeting in two weeks.
5) In looking at the antibiotics given this month, we became aware that the majority of the ancef ordered is
for 1gm, concern that most of our pts are over the 80kg weight. Will be presenting information at surgeons
meeting to remind about correct dosing.
6) Giving patients power for carbo-loading drink seems to improve compliance. Before we just asked patients
to arrange for their own drinks (usually juice).
7) Normothermia checked on patients of 3 surgeons. Only 1 patient was below recommended temp. Have
decided to expand our monitoring to see if patients from 2 other surgeons are warm as well.
8) Compliance with gum chewing improved early in the year when we began providing patients with gum, but
improvement has not continued. Exploring need for better patient education and staff training.
% of Patients with pre-admission counseling
100
90
80
70
60
50
40
30
20
10
0
Dec15
Nov15
Oct-15
Sep15
Aug15
Jul-15
Jun15
May15
Apr-15
Mar15
Feb15
Jan15
Baseli
ne
pt booklets
provided in
surgeons' offices
% of Patients with no bowel prep OR MBP +oral abx
Dec15
Nov15
Oct-15
Sep15
Aug15
Jul-15
Jun-15
May15
Apr-15
Mar-15
Feb-15
Jan-15
Baseli
ne
100
90
80
70
60
50
40
30
20
10
0
% of Patients with HS CHO + AM CHO
100
90
80
70
60
50
40
30
20
10
0
Dec15
Nov15
Oct-15
Sep15
Aug15
Jul-15
Jun15
May15
Apr-15
Mar15
Feb15
Jan15
Baseli
ne
started providing
pts with drink
Jul-15
Aug15
Sep15
Oct-15
Nov15
Dec15
Aug15
Sep15
Oct-15
Nov15
Dec15
May15
Apr-15
Mar15
Feb15
Jan-15
Baseli
ne
Jul-15
100
90
80
70
60
50
40
30
20
10
0
Jun-15
% of Abx redosing
Jun15
May15
Apr-15
Mar15
Feb15
Jan15
Baseli
ne
Dec15
Nov15
Oct-15
Sep15
Aug15
Jul-15
Jun-15
May15
Apr-15
Mar15
Feb15
Jan-15
Baseli
ne
% Abx prophylaxis
100
90
80
70
60
50
40
30
20
10
0
% Normal body temp on arrival to PAR
100
90
80
70
60
50
40
30
20
10
0
% Gum Chewing POD0 or POD1
100
90
80
70
60
50
40
30
20
10
0
Dec15
Nov15
Oct-15
Sep15
Aug15
Jul-15
Jun-15
May15
Apr-15
Mar15
Feb15
Jan-15
Baseli
ne
started provided
gum to pts by
nurse on POD0