Practice change in elective hip/knee in elective arthroplasty at Orange Health Service

Suzanne Lovell-smart 1

Orange Health Service, Orange, NSW, Australia


In 2014 the publication of the Australian Council on Healthcare Standards, Clinical Indicators user Manual version 4
INFC area 2: Surgical antibiotic prophylaxis (SAP) CI 2:1 – CI 2:6 regarding antibiotic usage in hip and knee prosthesis procedures was released for data collection.

The IP&C unit were confident that our service complied with the new recommendations and decided to do an audit and provide evidence for accreditation.

The results were astounding and lead to a two year project. It was a slow but sustainable practice change in both clinical and clincian behaviour.

Antibiotic usage did not meet the antibiotic theraeutic guidelines and over usage appeared to be linked with indwelling urinary catheters, which had become an imbedded practice over many years.

By analysing the surveilance data of SAP administration in conjunction with indwelling urinary catheter usage in elective arthoplasty, IP&C could provide evidence that could be used to drive clinicians practice/behaviour change in orthopaedic surgery and post-operative care.

Behaviour change is a long term commitment and at times is arduous, due human inertia factors. This required a committed team, education program and peer support implement (noun: tool or instrument of labour or verb; to complete fulfil or reform) change that would improve clinical quality and practice, which in turn lead to improved patient safety and outcomes.

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