Pre-Case Planning

Antimicrobial Prophylaxis Plan

Intraoperative Adjuncts Surgical Team Surgeon Anesthetist

Clinical Objective

Establish and document the complete antimicrobial prophylaxis plan for each case before surgery begins — including drug selection, dose, timing, redosing interval, and the individual responsible for confirming administration.

Why This Matters

The protective effect of perioperative antimicrobial prophylaxis is highly dependent on timing. Tissue drug concentrations must be adequate at the moment of incision. Administration that is delayed, underdosed, or not redosed in long procedures provides substantially reduced protection. A plan that is undocumented is a plan that can be forgotten, assumed, or duplicated. This protocol ensures that prophylaxis decisions are made once, clearly, and confirmed by a named individual — not improvised at induction.

Critical Control Points

Drug, dose, and timing decided during preoperative planning — not at induction
Administration timed to achieve adequate tissue concentration at incision
Redosing interval planned prospectively for all cases expected to exceed drug half-life
A named individual is responsible for confirming administration before incision

Prophylaxis Parameters

Complete for every case. All five parameters must be documented before the case proceeds.

Case Prophylaxis Plan

Drug selected

Dose

Timing target

Redosing interval

Confirms administration

Timing Reference

Target window: administration 30–60 minutes before incision

Target administration windowIncisionRedose trigger (if applicable)

Pre-Incision Confirmation Checklist

Prophylaxis Confirmation

Drug and dose confirmed as planned

No substitution or dose adjustment made without surgeon awareness.

Administration time recorded

Time noted to allow accurate calculation of redosing interval.

Timing window confirmed — within 30–60 min of incision

If administration is outside the window, surgeon is notified before proceeding.

Redosing plan confirmed if operative duration exceeds drug half-life

Anaesthesiologist or circulating nurse aware of trigger time for redose.

Responsible individual named and confirmed

One person explicitly accountable for tracking administration and redosing.

Step-by-Step Protocol

1
Select drug based on expected flora for the procedure type, site, and patient history. Adjust for known resistant organism history.
2
Calculate dose based on current patient weight. Document in the surgical plan.
3
Set timing target: administration 30–60 minutes before incision. Communicate to the anaesthesiologist.
4
Determine redosing interval based on the drug's half-life and estimated operative duration. Plan prospectively — do not wait until the case runs long.
5
Name the individual responsible for confirming administration. This must be explicit — shared responsibility defaults to no responsibility.
6
At the pre-incision briefing, confirm administration time aloud. Confirm redose trigger time is known.
7
Document all parameters and the confirmed administration time in the anaesthetic and surgical record.

Key Pitfalls

Administration timed to induction rather than incision — these may be separated by 30+ minutes in complex case setups.
No one explicitly named to confirm administration — assumed to have been done without verification.
Redosing interval not planned for long procedures — first dose protection lapses intraoperatively.
Drug or dose adjusted without surgeon notification.

What Actually Matters

Antimicrobial prophylaxis is not effective when it is given — it is effective when it is given at the right time, in the right amount, by someone who knows their role. A plan written down and confirmed aloud is the only version of this protocol that works.