Surgical Care Improvement Project - Pharmacy Process Improvement (Software)
Mark Wong, Pharm.D., BCPS1,2,3; George Melnik, Pharm.D., BCPS, 1,2
South Texas Veterans Health Care System (STVHCS)1, The University of Texas at Austin College of Pharmacy2,
The University of Texas Health Science Center at San Antonio3
Background
The Surgical Care Improvement Project (SCIP) is just one of the
Core Measures that is reported to Joint Commission (JCAHO)
and the Centers for Medicare/Medicaid services (CMS) by every
institutional facility that provides surgical care. The goal of SCIP
is to improve outcomes and reduce nationally the incidence of
surgical complications. Not only can JCAHO decide a hospital’s
accreditation on a facility’s SCIP performance compliance, but
a facility’s CMS reimbursement will be affected as well.
Part of the SCIP performance monitoring among other areas for
surgical services is proper antibiotic selection, its timeliness prior
to surgery & post-operative discontinuation, proper deep venous
thromboembolism (DVT) prophylaxis after surgery, and glucose
control in cardiac surgery patients. SCIP performance is
emphasized due to evidence showing reduced post-operative
complications and reduced length of stays. At the STVHCS,
these measures were not being fully met, and improvements were
needed.
Objectives
Starting back in October 2010, STVHCS began identifying what
changes could be made to improve compliance. A previous
attempt was made by utilizing quick-cards for the junior staff
physicians, but variation still existed. Another intervention was
to update the CPRS surgical order menus to make peri-operative
care more standardized. Our clinical pharmacy service identified
old CPRS menus as a potential target for improvement.
Pharmacy personnel in collaboration with the surgeons and
information technology specialists implemented these changes
mid-March. CPRS changes included more specific order menus
and quick orders for the surgical service for pre- and postoperative surgeries as well as a DVT prophylaxis menu for postoperative admissions.
Interventions
•Example of old antibiotic selection menu
Results
Table 1– SCIP Order Fallouts
CPRS order
interventions
•Added DVT prophylaxis order menus in surgery order sets
•Updated antibiotic selection menu (see example below)
Conclusion/Discussion
CPRS order menus periodically need to be updated. SCIP
measures improved just after implementing the new order
menus. In order to achieve a goal of 100% compliance, periodic
education on the use of the menus is still crucial as the quick
orders only work if the personnel uses them.
Bibliography
Bratzler DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement
from the National Surgical Infection Prevention Project. CID. 2004;38: 1706
Bratzler DW, Houck PE, Richards C, et al. Use of antimicrobial prophylaxis for major
surgery. Archives Surgery. 2005;140:174-182
Heit JA, O’Fallon WM, Petterson TM. Relative impact of risk factors for deep vein
thrombosis and pulmonary embolism. Arch Intern Med. 2002;12:1245-1248
Zerr, KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound
infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:335-361
Contact Information: Mark Wong, Pharm.D., South Texas Veterans Health Care System 7400 Merton Minter Boulevard (119) San Antonio, Texas 78229 E-mail: mark.wong@va.gov