Title : Providing antibiotic prophylaxis to patients with hip fractures in a district general hospital. Finding a solution to a problem.
Abstract:
Background: To prevent infections in orthopaedic surgeries, one dose of IV cefuroxime or flucloxacillin with gentamicin is recommended by NICE. Teicoplanin or vancomycin with gentamicin can be used if needed. Administering antibiotics within 24 hours of surgery reduces the risk of postoperative wound infections and improves outcomes. This project aims to ensure proper antibiotic prophylaxis for surgical patients with proximal femur fractures.
Methods: This was a retrospective quality improvement project involving patients admitted with proximal femur fractures at Kettering General Hospital between March and June 2022. We collected data from the internal hospital database (System C, CareFlow) and patient notes.
Results: Out of 101 patients, intraoperatively 90%(n=91) patients received Teicoplanin and Gentamycin, 4.9%(n=5) patients received Cefuroxime and 2.1(n=3) received Teicoplanin alone. Anaesthetic charts were missing for two patients. Post-operatively, 92%(n=72) received Teicoplanin, 3.9%(n=4) received Cefuroxime and 0.9%(n=1) received co-amoxiclav. Only 76%(n=77) received appropriate twenty-four post-operative antibiotic cover. Teicoplanin was not adjusted to patient’s weight or creatinine clearance. 1 patient had postoperative surgical wound infection.
Conclusions: Patients with Proximal Hip Fractures are currently receiving varying antibiotic prophylaxis regimes due to a lack of clear guidance. Additionally, prescriptions were being written on paper in theatres and electronically on the wards, causing a potential communication gap regarding the appropriate timing of the next dose.In order to tackle these concerns, our suggestion is to create a poster outlining an antibiotic prophylaxis guide, which we have placed in our theatres. Furthermore, we advise that the operating surgeon should prescribe all required doses on electronic records.
