手術預防性抗生素邏輯樹

元素資料收集和概率計算的決策途徑

Legend to the diagram:

步驟命名法：頭一個字表示手術傷口分類（1～4）、第二個字為一個字母以識別序列中的步驟、第三個字（如果有的話）是 "x" 表示該步驟不遵循指引。例如，{1ax} 意味著 "1" （清潔）手術傷口等級、"a" 識別序列中的此步驟、"x" 實行此步驟時沒有符合指引。
頭一個字 母"g" 指示外科手術部位感染的可能性 [g = ganran]. "Y" = 部位感染被鑑定
示為菱形的步驟表明途徑的分支。這取決於在菱形內的問題：回答 "Y" = yes 或 "N" = no

黃色背景的步驟 x ：未遵循指引，要求品質改進工作。

淺粉色背景的 g ：指示手術傷口感染的資料元素。

淡藍色背景 ： 表明完全符合指引的途徑。

相關指引

  • 手術安全查檢表
  • 手術全期血糖控制 (SCIP)
  • 手術全期體溫控制 (SCIP)
  • 除毛管理 (SCIP)

相關文獻

應收集的資料

術前

  • 病人
    • 知情同意
    • 執行手術的外科醫師，外科醫生將與患者做手術部位的切口標記
    • 體重（基本資料：性別/年齡/過敏史）
    • 空腹血糖
  • 手術
    • 預計執行的手術名稱/ICD碼/手術碼
    • 傷口分類：術前（遵從性）：一旦手術開始就不允許改變
  • 外科醫師/部門
  • 預計的抗生素（在這個階段）：
    • 種類/名稱
    • 劑量

在手術室內：手術劃刀前

  • 確認已經給抗生素
    • 種類/名稱
    • 劑量
  • 抗生素給藥時間點：術前

在手術室內：手術中

  • 手術
    • 術中有膿：Y=>改變傷口等級
  • 確認已經給抗生素
    • 種類/名稱
    • 劑量
  • 抗生素給藥時間點：術中（也許多次）
  • 在手術室內：縫合時間點

手術

  • 手術
    • 最終手術名稱/ICD碼/手術碼
    • 手術耗多長時間（分鐘）
    • 傷口分類：術後（記錄於傷口縫合的瞬間）：計算結果指標
  • 抗生素給藥時間點：術後（在手術室或恢復室）
  • 手術時間點：縫合的時間

手術後

  • 手術後：是否為醫療照護相關感染(HAI)？
  • 抗生素：是否停用？

Questions asked at each step of the guideline

{A} All operations
What does this include? Emergency, outpatients,...
{B} Type 3 , 4 surgical wound, or already using antibiotics preoperatively?
Therapeutic usage, leave prophylaxis pathway. Also, mainland china only monitors type 1 for hospital accreditation,...
{C} type 1 or type 2 surgical wound
Type 2 by definition must use prophylaxis. Type 1, in general, does not; but requires a separate step to identify the special cases that do...
{a} was an antibiotic given for "prophylaxis"?
Type 2 by definition must use prophylaxis. Type 1, in general, does not; but requires a separate step to identify the special cases that do...
{b} did the antibiotic selection agree with the guideline recommendations?
Type 2 by definition must use prophylaxis. Type 1, in general, does not; but requires a separate step to identify the special cases that do...
{c} was the antibiotic dosage appropriate, adjusted for patient's age and weight?
Type 2 by definition must use prophylaxis. Type 1, in general, does not; but requires a separate step to identify the special cases that do...
{d} was the antibiotic given preoperatively in the correct timeframe?
Type 2 by definition must use prophylaxis. Type 1, in general, does not; but requires a separate step to identify the special cases that do...
{e} did intra-operative findings change the decison (pus found and changed to therapeutic antibiotic)?
Intraoperative red "STOP" sign, leaves prophylaxis guideline pathway, but compliance assessed until here if do so.
{f} did operation time exceed the half-life of the prophylaxis antibiotic?
Intraoperative red STOP sign, leaves prophylaxis guideline pathway, but compliance assessed until here if do so.
{g} if {f}=Y, was supplemental dose(s) given during the operation?
Intraoperative red STOP sign, leaves prophylaxis guideline pathway, but compliance assessed until here if do so.
{h} was the prophylaxis antibiotic stopped postoperatively?
Intraoperative red STOP sign, leaves prophylaxis guideline pathway, but compliance assessed until here if do so.
{g} did the pathway result in surgical site infection?
Intraoperative red STOP sign, leaves prophylaxis guideline pathway, but compliance assessed until here if do so.