Preventing Surgical Site Infections in Patients with Penicillin Allergies
Project status
Collaborators
Amanda Binkley, PharmD
Naasha Talati, MD, MS
Olajumoke Fadugba, MD
Patrick Kim, MD, MHCI
Innovation leads
Opportunity
Approximately 10–15 percent of Penn Medicine patients have a noted penicillin allergy. For these patients, cefazolin is an antimicrobial that is more effective than many alternatives, such as vancomycin, used during surgical procedures to prevent surgical site infections (SSIs). Cefazolin also is much more likely to be administered before incision than vancomycin, which makes a difference for SSI risk. Despite its benefits, cefazolin is currently underused as a penicillin alternative during operations.
Intervention
To raise prescribing rates of cefazolin for surgery patients with a penicillin allergy, we are piloting a clinical support decision tool in the orthopaedics departments at two Penn Medicine hospitals. The tool leverages new technology available through AgileMD to provide an integrated and interactive decision tree to enable best practices in the pre-op setting, at the point of antibiotic ordering. The pilot study will also have arm that provides personalized feedback to clinicians on their prescribing behavior as compared to their peers.
Impact
The pilot study is in the planning stages. We plan to track changes in antimicrobial prescribing behavior and SSI occurrence to evaluate this intervention. Results will be posted here when available.
Innovation Methods
Journey map
Journey map
We developed detailed workflow for patient and clinician journeys from pre-operative appointments to day-of-surgery care to better understand pain points and decision-making processes for both stakeholders. We learned that multiple clinicians have touchpoints with patients to re-verify their allergies.
Journey map
A journey map is a visualization of a user's process to accomplish a task. Journey mapping involves plotting user actions onto a timeline.
Details on users' thoughts, emotions, and feedback are then added to the timeline to provide a holistic view of the experience or journey. Journey mapping will help you uncover what's working well in the current state and identify key pain points that need addressing.
You can build a journey map based on several users' observations, creating an archetype user journey, or you can use a template in real time as you conduct individual observations of users.
Assumptions matrix
Assumptions matrix
We identified decision points throughout clinician workflow that relied on assumptions to determine areas for onsite research. We found top assumptions were reliance on patient-reported allergies, clinician comfort with prescribing cefazolin, and that embedded drug alerts deter prescribing behavior.
Assumptions matrix
An assumption is a statement about something that must be true for your solution to work.
When you have defined a solution you'd like to test, ask yourself, "What must be true for this to work?" Once you have a complete list, plot your assumptions on a 2x2 matrix where one axis is how certain you are that your assumption is accurate and the other is how detrimental it will be if it is not.
Mapping assumptions will help you determine what you need to test to de-risk a potential solution. Assumptions that you are uncertain about and that are crucial for your solution to work are your riskiest assumptions.
Fake front end
Fake front end
We developed clickable mock-ups of the pilot clinician workflow and conducted virtual feedback sessions to observe ease of use and reactions to the new workflow. This informed the new format of the solution, which consists of small tweaks to the current workflow and accompanying emailed peer comparison report cards.