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Surgical Care Improvement Project

A Patient with Musculoskeletal Limitations Complicated by a Medical Illness
The Surgical Care Improvement Project (SCIP), was implemented as a commitment to
improving the safety of surgical patients by reducing post-operative complications. Although
some surgical complications are unavoidable, surgical care can be improved through better
adherence to evidence based practice.
Case Study: A 60-year old patient with a long standing history of right knee pain has been
diagnosed with osteoarthritis, and has been recommended a total left knee arthroscopy to
improve chronic discomfort and improve mobility.
The patient’s past medical history includes hypertension and an irregular heart rate. The patient
denies any allergies.
The patient reports to the hospital at 1 p.m. for a left knee replacement. A medication
reconciliation is completed, and the patient reports taking the following medications with a sip of
water at 8:00 p.m.:
� Lisinopril 10 mg PO daily
� Toprol 25 mg PO daily
� Celebrex 200 mg PO daily
While in the pre-operative holding area, vital signs are taken and are within normal limits. No
hair removal was performed. The patient was ordered and received Ancef 1 gram IV mini bag, at
2:30 p.m. The patient was transferred to the operating room, where anesthesia monitoring began
at 3:00 p.m., a urinary catheter was placed, and a forced air warming device was placed to
maintain the patient’s temperature.
After recovering in the post anesthesia care unit (PACU), the patient was transferred to a surgical
floor. Post-operative orders included:
� Ancef 1 gram IV mini bag every 8 hours
� Long leg TED hose and sequential compression stockings to right leg while in bed
� Lovenox 30 mg subcutaneously every morning, starting the following morning
� Urinary catheter to be discontinued at 3:00 p.m. on post-operative day 1
The patient progressed well, both with pain control and mobility. TED hose and sequential
compression stockings were worn while in bed. On the first post-operative day, the first dose of
Lovenox was administered at 1000 a.m. and the last dose of Ancef was received at 2:30 p.m. The
patient was able to void after removal of the urinary catheter. The patient progressed well and
was discharged home on post- operative day 5.
Evidence shows that more than 45 million operative procedures are performed in the United
States each year. Approximately 40% of operative procedures result in a surgical complication.
The Surgical Care Improvement Project (SCIP) was implemented to improve quality of care


surgical patients, by reducing surgical complications. Nurses play an important role in this
process by following and adhering to evidence based and best practice protocols.
Using evidence based practice from two professional nursing journals, and/or your nursing
textbooks, answer the following questions:

  1. Explain one of the SCIP core measures, and how it has impacted the prevention of surgical
    complications. 2. Explain why no hair removal was required for the surgical procedure. If hair
    removal were ordered, explain the appropriate technique.
  2. What methods were used to ensure that the recommended VTE/DVT prophylaxis was
    implemented, and why is the timing important? Explain your rationale with evidence.

Improvement of Surgical Care
Project Outline

Week 1
In the first week, the learner will focus on understanding the requirement of the paper.
The student will understand the presented case scenario and get ready to research on various
concepts as the study topic would suggest. The learner will seek clarification from the instructor
on areas that may not be clear. So as to acquire all the necessary information, the learner will
refer to reliable sources and build up a strong background regarding the study topic. The
researcher will figure out the requirements of the paper and purpose to include all vital concepts
in the project. The student will design appropriate approaches of answering the questions
presented in the paper. Also, the learner will purpose to apply evidence-based techniques to the
project. By the end of the week, the researcher will have a comprehensive understanding of the
requirements of the paper.


Week 2
The student will start developing an outline of the paper by the second week. The outline
should satisfy the requirements of the paper. The learner will set objectives that would be
achieved within a given period. The learner will ensure that the objectives are measurable,
strategic, applicable, and that they are reliable. The outline should include the major activities
that the leaner would engage in. As such, the learner will refer to the outline and the tool will
serve the purpose of a reminder. The outline will be set in a way that the completion of a
particular task would facilitate that of subsequent ones. The researcher will establish the outline
in a way that would be easy to develop it and make changes where necessary. The initial
components of the outline will incorporate introductory concepts to the study project.
Week 3
The learner will complete the outline in the third week. The completed outline will serve
as a guide in addressing the study problem. The researcher will use the outline to assess different
issues and make independent judgments. The outline will summarize the requirements of the
paper and match their expected time of completion. The learner will focus on addressing the
entries in the outline and make achievements within the specified time. The outline will be
organized in such a way that it would be possible to address the requirements of the project
strategically. The learner will purpose to apply the completed outline to the presented case study.
By the time of completing the outline, the learner will have understood most of the concepts
included in the project. The format of the paper will match that of the completed outline both in
its arrangement and content.
Week 4


By the fourth week, the learner will start writing the paper while referring to the outline.
The student will meet the objectives of the outline when addressing the issues highlighted in the
case study. By the fourth week, the learner will have addressed about the first third of the
requirements included in the outline. The student will refer to scholarly work when researching
the issues highlighted in the timeline. The paper will address various concepts exhaustively and
include authoritative references so that readers can easily validate the writer’s strong assertions.
The paper will be well-organized and its presentation will be friendly to readers. The concepts
addressed in the first part of the paper will later be applied to subsequent parts so that the entire
paper will be coherent. Having questions thoroughly addressed will facilitate the handling of
subsequent issues in the outline.
Week 5
The learner will continue applying the outline to address issues included in it. By the end
of the week, the researcher will have handled about two thirds of the paper. The learner will
interlink the topics of week four with those of week five so that the paper would have a high
degree of consistency. The student will address the requirements of the paper in such a way that
the paper interlinks with the case study and it meets the objectives included in the outline. The
paper will reflect a scholarly structure in its organization and format. Concepts addressed in
week five will apply to the subsequent week, and it would be necessary to make validated
assertions. The student will ensure that the paper maintains high quality mainly by enhancing its
consistency with the outline and the case study.
Week 6


It will be the last week of the paper, and the learner will complete the remaining part of
the task. The student will merge different sections of the paper so that they are in a presentable
format. The learner will go through the whole paper and ensure that it is coherent from the
beginning. The student will correct any errors that may have occurred and ensure that the general
presentation of concepts meets scholarly standards. The learner will make a summary of the
addressed issues since the first week to the sixth. The summary will be tied to the outline
developed at the beginning of the project. The researcher will also make a conclusion at the end
of the paper regarding the studied topic. The researcher will then present the paper to the
instructor for marking.

Improvement of Surgical Care

Care for the patient in the case study was directed toward the prevention of acquisition of
surgical site infections. The involved health professional was directed by the guidelines of
Surgical Care Improvement Project (SCIP). Some of the practices performed were the core
measures advocated by SCIP (Weston, Caldera, & Doron, 2013).
Core Measure: the Prophylactic Administration of an Antibiotic Medication within an

Hour to Surgical Operation

The patient in the case study received a dose of intravenous cefazolin (Ancef) prior to
undergoing the operation. The drug is a cephalosporin and it works against a wide range of
bacteria. Therefore, the medication would protect the patient from acquiring bacterial infections
that would be most possible when bacterial colonies get into contact with open surgical wounds.
SCIP measures recommend the application of antimicrobial medications at most an hour to the
first incision or performance of surgery. The early administration of the agent gives it enough


time to establish and attain a bactericidal serum concentration by the time of the operation
(Goede, Lovely, Thompson, & Cima, 2013, Pg. 563). Untimely application of prophylactic
antimicrobials would raise the risk of patients acquiring nosocomial infections regardless of
whether they receive the medication or not (Turk, Karagulle, Serefhanoglu, Turan, & Moray,
2013, Pg. 583). Studies relate longer time durations between antibiotic treatment and the
beginning of surgery to a high likelihood of acquiring bacterial infections.
The practice had beneficial yields as the patient did not report complications after the
operation (Weston, Caldera, & Doron, 2013). In addition to promoting patient safety, the move
was also important in upholding hospital guidelines of standard care. Guidelines specifying the
procedural activities involved and the specific antimicrobials for use would promote the
development of a healthy culture in the healthcare institution (Wang, Chen, Ward, &
Bhattacharyya, 2012).

The Basis for Avoiding Hair Removal during the Operation
Hair removal is not always necessary when performing a surgical operation (Poggio,
2013, Pg. 171). There is substantial scientific evidence against hair removal under certain
circumstances. Previously, the activity was understood to improve hygiene at the surgical site
hence protecting patients from infections. Later understandings revealed possibilities that the
practice predisposed people to disease infections (Poggio, 2013, Pg. 171). Usually, hair removal
creates an avenue for the entry of bacteria into the body. Bacteria get entry into the body through
abrasions and microscopic nicks created after hair removal. It was necessary to avoid the practice
so as to maintain the integrity of the patient’s skin and promote his safety.


Had hair removal been ordered, it would have been necessary to perform it in the safest
way possible. The practice should have been performed in a way that it does not create abrasions
that would later be the entry points of bacteria into the body. The practitioner would have
considered shaving the surgical site approximately twelve hours to the operation rather than just
before it. The clinician would also have used electric clippers rather than manually operated
shaving razors (Crolla, van der Laan, Veen, Hendriks, van Schendel, & Kluytmans, 2012).
Clippers are not as much likely to cause many tears as razors would have resulted. Other reasons
for the selection of electrical clippers at the expense of the manually operated ones include
patients would not experience razor burns, and instead, the method would leave hair stubbles on
the skin surface. It is conclusive that use of electric clippers would place patients at reduced risks
of infections than would have been the case had manual razors been the choice.
Methods that Ensured the Implementation of VTE/DVT Prophylaxis
There are several practices in the case study involving the prevention of deep vein
thrombosis and venous thromboembolism. They include the use of compression stockings as
approaches to preventing DVT and VTE. The TED hose applied on the patient in the case
scenario prevent the occurrence of DVT by facilitating venous blood flow and lymphatic
drainage in the legs of the patients. The stockings would work best when patients are lying as in
the case study. Usually, the stockings are supposed to compress blood vessels from the ankle up
the legs to facilitate the return of blood to the heart. They therefore overcome the risk of
developing DVT whose pathophysiology entails poor blood flow to the lower limbs, blood
pooling, and the eventual formation of emboli. Compression stockings are usually made of
elastic material and fiber and clinicians should ensure that they recommend the use of
compressional stockings of the appropriate strength.


There were also pharmacological approaches applied to prevent the two complications in
patients. Lovenox is an effective medication in the prevention and management of DVT
(Pannucci, Wachtman, Dreszer, Bailey, Portschy, Hamill, & Wilkins, 2012, Pg. 165). The agent
prevents the formation of blood clots and so emboli. It was necessary to administer the drug to
the patient as surgical patients have a high predisposition to the development of blood clots and
embolism. Before administering lovenox, prescribers should first assess the patient for
indications suggesting that they have a low count of platelets. 2the use of the drug in such
patients could have severe adversities such as prolonged bleeding. The drug works well in
patients undergoing surgical treatment and its use in the case study was appropriate.




Crolla, R. M. P. H., van der Laan, L., Veen, E. J., Hendriks, Y., van Schendel, C., & Kluytmans,
J. (2012). Reduction of Surgical Site Infections after Implementation of a Bundle of Care.
PLoS ONE, 7(9), e44599.
Goede, W. J., Lovely, J. K., Thompson, R. L., & Cima, R. R. (2013). Assessment of Prophylactic
Antibiotic Use in Patients with Surgical Site Infections. Hospital Pharmacy, 48(7),
Pannucci, C. J., Wachtman, C. F., Dreszer, G., Bailey, S. H., Portschy, P. R., Hamill, J. B., …
Wilkins, E. G. (2012). The effect of post-operative enoxaparin on risk for re-operative
hematoma. Plastic and Reconstructive Surgery, 129(1), 160–168.

Poggio, J. L. (2013). Perioperative Strategies to Prevent Surgical-Site Infection. Clinics in Colon
and Rectal Surgery, 26(3), 168–173.


Turk, E., Karagulle, E., Serefhanoglu, K., Turan, H., & Moray, G. (2013). Effect of Cefazolin
Prophylaxis on Postoperative Infectious Complications in Elective Laparoscopic
Cholecystectomy: A Prospective Randomized Study. Iranian Red Crescent Medical
Journal, 15(7), 581–586.
Wang, Z., Chen, F., Ward, M., & Bhattacharyya, T. (2012). Compliance with Surgical Care
Improvement Project Measures and Hospital-Associated Infections Following Hip
Arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 94(15),
Weston, A., Caldera, K., & Doron, S. (2013). Surgical Care Improvement Project in the Value-
Based Purchasing Era: More Harm Than Good? Clinical Infectious Diseases: An Official
Publication of the Infectious Diseases Society of America, 56(3), 424–427.

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