Title : Management of open fractures: Assessment of adherence to BOA guidelines regarding duration of antibiotics and timing of administration
Abstract:
Background: Open fractures require timely multidisciplinary management to enable optimum recovery and to minimise the risk of infection. British Orthopaedics Association Guidelines recommend administration of prophylactic antibiotics as soon as possible, ideally within 1 hour of injury. In our unit, there were incidences where antibiotics were administered for an inappropriate duration or that they were not administered within 1 hour.
Objectives: An audit was completed to collect data on antibiotic prescribing practices before and after introducing a prescribing bundle on Electronic Prescribing and Medicines Administration systems to monitor and to help improve the adherence to the British Orthopaedic Association Standards for Trauma and Orthopaedics.
Study Design and Methods: A retrospective study was formed in which patients’ data was collected from T&O trauma data base. Data collection was completed along one month pre-intervention and one-month post-intervention. The inclusion criteria was any open fracture except for those listed in the exclusion criteria. Any patients with open fractures of midfoot, forefoot, and hand were excluded. The data points collected include whether antibiotics were administered, the antibiotic choice was correct, the antibiotic duration was correct, and antibiotics were given within one hour...
Descriptive statistics was used to analyse the results to compare prescribing practices pre and post introducing the Electronic Prescribing and Medicines Administration systems bundle. This bundle was in collaboration discussions with the head of service and microbiology team and prescribes the correct antibiotics for the correct length of time.
Results: Sample size for pre and post intervention groups were 22 patients in each. There was 100% (n=22) adherence to guidelines for antibiotics being given and the correct antibiotics given in both the pre-and post- intervention group. The appropriate duration was prescribed correctly 73% (n=16) in the pre-intervention group, and it improved to 77% (n=17) post-intervention. A bigger improvement was reflected in administration of antibiotics within 1 hour from 18% (n=4) to 55% (n=12).
Conclusion: Early administration of intravenous antibiotics for treatment of open fractures is mandatory to minimise the risk of infection and to improve clinical outcome for patients. Implementation of the antibiotic bundle in our hospital has improved the management of patient as per guidelines which improved the outcome of open fracture management in our hospital.
