Multidisciplinary Facial Fracture Antibiotic Prophylaxis Guideline: Barriers to Implementation in Practice

Authors:
Terra Hill, Stepheny Berry, Robert Winfield, John Flynn, Clint Humphrey, Duncan Nickerson, Matt Shoemaker, Christopher Guidry

Body of Abstract:
Introduction: Despite evidence against the use of prophylactic antibiotics for patients with facial fractures, their use remains widespread. Our institution created a multidisciplinary practice management guideline (PMG) recommending against the use of prophylactic antibiotics for these patients; however, rates of use were persistent. This study evaluates the perception and beliefs of our multidisciplinary team to assess barriers of the PMG implementation,

Methods: An IRB-approved, REDCap-generated survey was administered to Advanced Practice Providers (APPs), Trainees (Residents and Fellows), and Faculty in the departments of Trauma, Ophthalmology, Otolaryngology (ENT), and Plastic and Reconstructive Surgery (PRS) regarding the perception and beliefs of prophylactic antibiotic use for traumatic facial fractures. This study was conducted at our American College of Surgeons (ACS)-verified Level I Trauma Center. Chi-square and Kruskal-Wallis analyses were conducted.

Results: The survey response rate was 48.4% (75/155). The respondents were primarily trainees (38, 50.6%) and affiliated within the Trauma department (33, 44%). The unawareness of an existing PMG included 9 (100%) Ophthalmology providers, 11 (57.9%) of PRS providers, and 6 (42.9%) of ENT providers (p < 0.0001). The lack of awareness was not statistically significantly different amongst different levels of providers (p= 0.12). In addition, 17 (51.5%) of Trauma providers do not believe prophylactic antibiotics reduce the risk of infection for traumatic facial fractures, whereas 7 (77.8%) of Ophthalmology providers, 7 (50%) of ENT providers, and 16 (84.2%) of PRS providers believes that the risk can vary (p= 0.004). This belief was not statistically significantly different amongst different levels of providers (p= 0.69). Conclusion: Barriers to implementing a multidisciplinary PMG include persistent beliefs in antibiotic prophylaxis, lack of shared medical knowledge, as well as the lack of information sharing between departments. When creating a multidisciplinary PMG, inclusion of all impacted providers should be considered to effectively implement new changes to clinical practices.