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SCIP- Inpatient & Outpatient Procedures

INPATIENT
Surgical Care Improvement Project (SCIP)
SCIP MEASURES Compliance / Documentation Tips
SCIP 1: Antibiotics started within one hour before surgical incision, (within 2 hours for vancomycin or fluoroquinolones). Use EMR order sets. Anesthesiologist or CRNA starts antibiotic in OR within 60 minutes before incision. Document actual time and route.
SCIP 2: Antibiotic selections for the surgery type are consistent with CMS SCIP recommendations. Use EMR SCIP order sets. Document the reason for vancomycin use pre-operatively. Follow CMS SCIP guidelines for antibiotic selection for surgery type.
SCIP 3: Antibiotics are discontinued within 24 hours of anesthesia end time (within 48 hours for cardiac surgery patients). Dose or time-limit antibiotic orders. Document a specific reason for continued antibiotics beyond 24 hrs such as actual or suspected infection. The clock starts at documented anesthesia end time. Documentation of the infection must be within 2 days (3 days for cardiac) after anesthesia end time.
SCIP 4: Cardiac surgery patients with controlled blood glucose (less than or equal to 180 mg/dL) in the timeframe of 18-24 hours after Anesthesia End Time. Order serum glucose 18-24 hrs after anesthesia end time.
SCIP 6: Surgery Patients with Appropriate Hair Removal Complete hair removal per DMC policy.
SCIP 9: Surgical patients with urinary catheter removed on Postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero. Document the specific reason(s) for Continuing Catheter beyond end of POD 2, and documentation must be done on POD 1 or 2. Document removal of foley catheter.
SCIP CARD 2: Surgery Patients on Beta-Blocker therapy prior to arrival who received a beta-blocker during the perioperative period (defined as the day prior to surgery through POD 2 with day of surgery being day zero. Assess home med regimen for beta blockers (even if pre-op order includes beta blocker), and if taking beta blockers at home, document date/time of last beta blocker dose. Then document administration of beta-blocker: on the day prior to or the day of surgery, and on POD 1 and POD 2. Document any contraindication to BB in widget. Must document reason each day the BB is held or not given.
SCIP VTE 2: Patients received appropriate VTE prophylaxis between 24 hours pre- anesthesia start time and 24 hours after anesthesia end time. See DMC VTE Prophylaxis Protocol G:\PCCWHIT\whit2\Core Measures_DMC VTE Prophylaxis Decision Support 5_2014 v3.doc. Document the reason if no mechanical and/or pharmacological prophylaxis was used, within the timeframe of arrival to 24 hours after anesthesia end time.

Prophylactic Antibiotic Regimen Selection for Surgery

PROCEDURE / Risks Antibiotics
CABG, CARDIAC, VASCULAR Cefazolin or Cefuroxime OR Vancomycin (Use only if Beta Lactam Allergy or MRSA Risk or Physician/PA/ARNP/Pharmacist documentation of indication)
Or
Use both Vancomycin + cefazolin if prosthetic materials or implants
CABG, CARDIAC, VASCULAR with Beta Lactam Allergy Clindamycin OR Vancomycin (vascular or cardiac)
Vancomycin + Aztreonam if cardiac prosthetic materials or implants
HIP / KNEE Cefazolin or Cefuroxime OR Vancomycin (Use only if Beta Lactam Allergy or MRSA Risk or Physician/PA/ARNP/Pharmacist documentation of indication)
Use both Vancomycin + Cefazolin if prosthetic materials or implants
HIP / KNEE with Beta Lactam Allergy Clindamycin OR Vancomycin
Colon Cefotetan OR Ampicillin/Sulbactam OR Ertapenem (a single dose of Ertapenem is recommended for Colon) or Ceftriaxone + metronidazole
OR
Cefazolin PLUS Metronidazole
OR
Cefuroxime PLUS Metronidazole
OR
Ceftriaxone PLUS Metronidazole
Colon with Beta Lactam Allergy Clindamycin PLUS Aminoglycoside (Gentamicin)
OR
Clindamycin PLUS Quinolone
OR
Clindamycin PLUS Aztrenoam
OR
Metronidazole PLUS Aminoglycoside
OR
Metronidazole PLUS Quinolone
Hysterectomy (Abd or Vaginal) Cefotetan OR Cefazolin OR Cefoxitin OR Cefuroxime OR Ampicillin/Sulbactam
Hysterectomy With Beta Lactam Allergy Clindamycin PLUS Aminoglycoside
OR
Clindamycin PLUS Quinolone
OR
Clindamycin PLUS Aztreonam
OR
Metronidazole PLUS Aminoglycoside
OR
Metronidazole PLUS Quinolone
OR
Vancomycin PLUS Aminoglycoside
OR
Vancomycin PLUS Aztreonam
OR
Vancomycin PLUS Quinolone
Principal Procedure Code of Abdominal or Vaginal Hysterectomy with an Other Procedure Code of Colon Surgery with Beta Lactam Allergy OR Vaginal Cefotetan OR Cefuroxime OR Ampicillin/Sulbactam OR Ertapenem

Cefazolin + Gentamicin OR Ceftriaxone + Metronidazole

Principal Procedure Code of Abdominal or Vaginal Hysterectomy with an Other Procedure Code of Colon Surgery with BETA LACTAM ALLERGY Clindamycin PLUS Aminoglycoside
OR
Clindamycin PLUS Quinolone
OR
Clindamycin PLUS Aztreonam
OR
Metronidazole PLUS Aminoglycoside
OR
Metronidazole PLUS Quinolone
OR
Vancomycin PLUS Aminoglycoside
OR
Vancomycin PLUS Aztreonam
OR
Vancomycin PLUS Quinolone
OUTPATIENT
Surgical Prophylactic Antibiotic Selection
Surgical Procedure Antibiotics Antibiotics for β-lactam allergy
Neurological Cefazolin (no prosthetic material or implant) OR
Cefuroxime OR
Vancomycin* OR
Clindamycin OR
Cefazolin + Vancomycin (with prosthetic materials or implants)
Head and Neck Cefazolin OR
Ampicillin / Sulbactam OR
Cefuroxime OR
Clindamycin +/- Aminoglycoside OR
Vancomycin * OR
Cardiac (Pacemakers or AICDs) or Vascular Cefazolin (no prosthetic material or implant) OR
Cefuroxime OR
Vancomycin* OR
Cefazolin + Vancomyin (with prosthetic material or implant)
Vancomycin or
Clindamycin
Gastric/Biliary PEG Placement Cefazolin OR Cefuroxime OR
Cefoxitin OR Cefotetan OR
Ampicillin/Sulbactam OR
Cefazolin + Metronidazole OR
Cefuroxime + Metronidazole OR
Vancomycin *
Clindamycin +/- Aminoglycoside OR
Clindamycin +/- Quinolone OR
Vancomycin +/- Aminoglycoside OR
Vancomycin +/- Quinolone
Gynecological Laparoscopic Assisted Hysterectomy, Vaginal Hysterectomy Cefazolin or Cefuroxime OR
Cefoxitin or Cefotetan OR
Ampicillin/Sulbactam OR
Metronidazole + Aminoglycoside OR
Metronidazole + Quinolone OR
Clindamycin + Aminoglycoside OR
Clindamycin + Aztreonam OR
Clindamycin + Quinolone OR
Vancomycin + Aminoglycoside OR
Vancomycin + Aztreonam OR
Vancomycin + Quinolone
pubo-vaginal sling 1st Generation cephalosporin OR
OR 2nd Generation cephalosporin OR
Ampicillin/Sulbactam OR
Quinolone OR
Aminoglycoside + Clindamycin OR
Aminoglycoside + Metronidazole OR
Aztreonam + Clindamycin OR
Aztreonam + Metronidazole
Genitourinary Prostate Biopsy†† Treat according to culture, if positive, otherwise use Ciprofloxacin (Quinolone†) OR
Sulfamethoxazole/Trimethoprim† OR
1st Generation cephalosporin OR
2nd Generation cephalosporin OR
3rd Generation cephalosporin OR
Aminoglycoside OR
Aztreonam
Genitourinary Penile prosthesis insertion, removal, revision Treat according to culture, if positive, otherwise use Cefazolin or Gentamicin
Ampicillin/Sulbactam OR Ticarcillin/Clavulanate OR Pipercillin/Tazobactam OR
OR Aminoglycoside + 1st Generation cephalosporin OR
OR Aminoglycoside+ 2nd Generation cephalosporin OR
OR Aminoglycoside + Vancomycin OR
OR Aminoglycoside + Clindamycin OR
OR Aztreonam + 1st Generation cephalosporin OR
OR Aztreonam + 2nd Generation cephalosporin OR
OR Aztreonam + Vancomycin OR
OR Aztreonam + Clindamycin OR
Orthopedic/Podiatry Cefazolin (no prosthetic material or implant)
Cefuroxime or
Vancomycin*
Cefazolin + vancomycin (with prosthetic material or implant)
Vancomycin or
Clindamycin
  • All SCIP IV antibiotic doses should be given within 60 min (exception: vancomycin or fluoroquinolones within 120 min) prior to incision.
  • A single antibiotic dose is recommended if the operation is less than 3 hours. If prophylactic antibiotics are continued post-operatively, discontinuation within 24 hours is recommended. Prophylactic antibiotics continued for more than 24 hours after anesthesia end time (48 hours for cardiac patients) must have a specific justification documented in the progress notes.
  • For cardiac, orthopedic, and vascular surgery, if the patient is allergic to beta-lactam antibiotics, vancomycin or clindamycin are acceptable substitutes.
  • A single dose of ertapenem is recommended for colon procedures.
  • ** The Combination of ceftriaxone with metronidazole for colon surgery should only be used in hospitals where surgical site infection surveillance demonstrates gram negative surgical infections resistant to first and second generation cephalosporins. Routine use is not recommended.
  • *Vancomycin is acceptable with a physician/APN/PA/pharmacist documented justification for its use (see data element vancomycin).
  • †The only operations for which oral antibiotics alone are acceptable are the prostate biopsy and pubovaginal sling procedures.
  • †† The only operations for which intramuscular antibiotics alone are acceptable are the prostate biopsy procedures.