Impact of a perioperative pharmacist on completion rates for preoperative antibiotics

Background: Ensuring appropriate use of preoperative antibiotics and monitoring antibiotic administration timing are responsibilities a perioperative pharmacist may perform. Antibiotics requiring prolonged infusions such as vancomycin and fluoroquinolones should be administered within 120 min of the first surgical incision. These antibiotics require longer infusion times, so they may not be completed before the first surgical incision. Incomplete infusions may cause procedural delays and increase the risk of surgical infections. By implementing a perioperative pharmacist, we aim to increase the percentage of completed infusions of presurgical antibiotics that require prolonged administration times, which may decrease the incidence of postsurgical skin and soft tissue infections and urinary tract infections. Methods: This retrospective cohort analysis compared the completion rates of prolonged infusion preoperative antibiotics between pre- and post-implementation of a perioperative pharmacist. Antibiotics of interest were those with infusion times of 60 min or greater which included vancomycin, ciprofloxacin, and levofloxacin. A survey was constructed to evaluate perioperative staff satisfaction with the Department of Pharmacy pre- and post-implementation of a perioperative pharmacist. Results: Assessing presurgical antibiotic doses, 59.6% of vancomycin, ciprofloxacin, and levofloxacin were completely infused prior to the first surgical incision during the perioperative pharmacist pilot compared with 26.5% pre-implementation (p<0.001). A difference in the incidence of postsurgical skin and soft tissue infections and urinary tract infections within 30-days postoperatively was not detected. In the perioperative staff satisfaction survey, the statement: "a pharmacist in the perioperative setting improves patient care" was answered strongly agree or agree in 95% of respondents in the post-survey as compared to 71% in the pre-survey. Furthermore, 95% of the perioperative staff that completed the post-survey supported the continuation of a perioperative pharmacist role indefinitely. Conclusion: Implementation of a perioperative pharmacist increased presurgical antibiotic prophylaxis infusion completion rates of vancomycin, ciprofloxacin, and levofloxacin and increased perioperative staff satisfaction with the Department of Pharmacy.