Extract
Antimicrobial prophylaxis reduces the incidence of surgical site infection
for many
procedures1.
Nonetheless, these medications are not always given
appropriately2. This
failure may stem from a diffusion of
responsibility3:
both the surgeon and the anesthesiologist may assume that the other has
attended to this issue. The root cause, we believe, is the reliance on human
action, which invites avoidable error and demands fail-safe routines.To that end, we have incorporated a check on antimicrobial prophylaxis into
the "time-out" mandated by the United States Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) in the "Universal
Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person
Surgery."4 Our
time-out comprises four questions, the first three of which are part of the
JCAHO standard: