Improving surgical care: Pharmacists play vital role

February 21, 2005

An ambitious project to reduce surgical complications by 25% within five years includes a vital role for hospital pharmacists, say members of the Surgical Care Improvement Project (SCIP).

"Pharmacists play a critical role in monitoring the use of antibiotics and in meeting the standards for prophylactic use of antibiotics set by the project," said Marianne Billeter, Pharm.D., a clinical pharmacy specialist in the infectious disease department of the Ochsner Clinic Foundation in New Orleans. She is also a pharmacist member of the Joint Commission on Accreditation of Healthcare Organizations' Infection Control Expert Panel and helped design the SCIP guidelines.

"We should be actively involved in any infectious disease quality improvement projects at the hospital level," said Cynthia LaCivita, Pharm.D., director of clinical standards and quality for ASHP. That role includes monitoring infection rates, participating in the selection of antibiotics, and determining when to initiate and terminate antibiotic prophylactic administration. Of the more than 42 million surgeries performed in the United States each year, up to 40% have associated postoperative complications. A significant percentage of these are preventable, say SCIP officials.

The initiative, formerly known as the Surgical Infection Prevention (SIP) project, began in 2003. It sought to develop quality improvement guidelines, which included standards for peri- and post-operative care-an area of vital concern to pharmacists and patients. SSIs account for 14% to 16% of all nosocomial infections and are among the more common complications of care, according to SCIP. SCIP's surgical site infection guidelines call for four specific pharmacy-related standards:

Another area where health- system pharmacists are critical to infection control is in monitoring drug shortages and providing the information necessary for choosing alternatives, said LaCivita. (ASHP maintains a Web site for this purpose, at http://www.ashp.org/shortage/.) Additional measures are also being evaluated. These include prevention of hypothermia during the surgical procedure, maintaining high levels of inspired oxygen, controlling serum glucose within certain limits, and avoiding shaving of the operation site.

It is in the area of reduced SSIs that health-system pharmacists play a most vital role. ASHP has guidelines for the reduction of SSIs, which have "served as the backbone of the SCIP guidelines on surgical prophylaxis," said LaCivita. "Today our members are recognized as a vital part of the medical team. Active involvement in helping reduce SSIs as part of any multidisciplinary project is a critical part of what we can accomplish."

More information on SCIP is available at http://www.MedQIC.org/scip