SCIP

Question 1

SCIP =

Answer 1

Surgical care improvement project

Question 2

Surgical care improvement project (SCIP) is an initiative that is ran through _____ which is an umbrella over ______ (2)

Answer 2

HHS
(US Department of Health & Human Services)

1. CMS (Center of medicaid/medicare services)
2. CDC (center of disease control &. prevention)

Question 3

________ is the main reason why pts end up staying in the hospital longer. It increases their stay by ______ & their total cost by _______.

Answer 3

Surgical infection

A week (7 days)

$3,000

Question 4

Complications from surgical infections lasting ______ days decrease median survival by ____%

Answer 4

30

69%

Question 5

SIP =

Answer 5

Surgical infection prevention project

Question 6

What is the goal of SIP?

Answer 6

Decrease morbidity & mortality of SSI (surgical site infection infections)

Question 7

What are the performance measures for Abx rt SCIP? (3) Why are these important? (2)

Answer 7

1. Proportion of pts who get abx started w/i 1 hrs
2. Proportion given abx regimen consistent w/ guidelines
3. Porportion of pts whose abx is d/c w/i 24hrs of sx stop

Importance:
1. The timing of infusion & selection of the appropriate abx have a positive correlation w/ SSI incidence

2. Duration of prophylaxis & excessive usage promotes bacterial resistance

Question 8

_________ (3) are started w/i 2 hrs of incision? Why?

Answer 8

1. Vancomycin
2. Fluoroquinolone
3. Clindamycin

dt long infusion times

Question 9

From the 2001 retrospective review, what percentage of cases get the abx within 1 hr of incision? Correct agent? D/c w/i 24h of sx stop? What does this infer?

Answer 9

Within 1hr: 55.7%

Correct agent: 92.6%

D/c w/i 24 hr: 40.7%

This means that most were d/c well after the 24hr which increases the risk of resistance

Question 10

T/F: The timing for Abx has improved since the 2001 study

Answer 10

T

BUT still not outstanding

Question 11

When did SCIP began? What was their goal?

Answer 11

2005

Reduce surgical complications by 25% by 2010
- Aimed at reducing surgical mortality & morbidity

Question 12

________ (2) initiated the SCIP protocols

Answer 12

1. CMS
2. CDC

Question 13

Who is on the SCIP “Steering committee”? (10) Who is not on this committee?

Answer 13

1. Agency for healthcare research & quality
2. American college of surgeons
3. American Hospital Association
4. American Society of anesthesiologist
5. Association of preoperative registered nurses
6. Center of disease control & prevent
7. Center for Medicare & Medicaid services
8. Department of Veterans Affairs
9. Institute for healthcare improvement
10. Joint commission on accreditation of healthcare organizations

Not on the committee:
CRNAs :(

Question 14

What are the Abx measures for SCIP protocol? (3)

Answer 14

1. Start abx w/i 1 hrs of incision (ABX 1)
2. Given correct abx regimen based on the procedure (ABX 2)
3. D/c the abx w/i 24hrs of sx stop unless there is a documented/suspected infection (ABX 3)

Question 15

What are the exceptions to the Abx measures for SCIP protocol? (2)

Answer 15

1. Vancomycin & Fluoroquinolone start w/i 2 hrs of incision
2. D/c Abx w/i 48hrs for cardiac Sx

Question 16

T/F: An open wound/fx is considered a suspected infection therefore we can continue the abx beyond 24 hrs

Answer 16

T

Question 17

What are the beta blocker measures for SCIP protocol? (2)

Answer 17

1. BB must be taken w/i 24hr of sx start for all pts on chronic BB therapy (BB 1)
2. BB restarted after sx for all pts on chronic BB therapy (BB 2)

Question 18

What are the hair measures for SCIP protocol? (2) Please explain why these are in place?

Answer 18

1. Documentation of appropriate hair removal w/ Electric clippers only (HAIR)
2. Do not use a razor/shaver!!!!!

This is in place dt the fact that razors create an abrasive surface –> increase infection risk

Question 19

What are the foley measures for SCIP protocol? (3)

Answer 19

1. Foley needs to be removed on/before postop day 2 unless in order exist to extend the catheter (FOLEY)
2. Reason to extend must be documented

(Reason to extend may not be written on postop admission orders)

Question 20

What are the Sugar measures for SCIP protocol? (2)

Answer 20

1. Cardiac pts w/ controlled postop blood glucose of </= 200mg/dl at 6am
2. 180 mg/dl w/i 18-24 hrs after anestthesia end for cardiac pts (SUGAR)

Question 21

What are the DVT measures for SCIP protocol? (3)

Answer 21

1. SCDs place during sx for all procedures >/= 1hr (DVT 1)
2. Orders for appropriate DVT prophylaxis (mechanical/pharmacological) on postop admission orders (DVT 2)
3. RN administration of appropriate DCT prophylaxis w/i 24hrs of sx end (DVT 3)

Question 22

What do you need to do if you did NOT include DVT prophylaxis according to SCIP protocol?

Answer 22

Document criteria for not administering pharmacological/mechanical prophylaxis

Question 23

What are the Temperature measures for SCIP protocol? (2)

Answer 23

1. Normothermia or active warming in OR
2. 1st temp in PACU has to be >/= 96.8F w/i 15mins of leaving OR

Question 24

Temperature was added to SCIP in _____

Answer 24

2010