This portion will be filled-out by QM.

Performance Indicator ID: KPI-N-SUR-CI-P-001

Performance Indicator Form

Date Submitted: Team/ Committee / Department: Process Owner / Title:
January 11, 2022 Surgery Department Dr. Muhammad Al-Gailani, Head of Surgery Department
Indicator No: Indicator Title: Definition:
001 Prophylactic Antibiotic Received within One Measure the time for administering the prophylactic antibiotic
prior to surgical knee arthroplasty.
Hour Prior to Surgical Incision Knee Arthroplasty
Type of Indicator: Choose one Rationale for Indicator Selection: Choose one Dimension of Quality: Choose one
 Structure  Evaluation of process /  High Cost  Appropriateness  Efficiency
 Process project  High Risk  Availability  Prevention / Early
 Outcome  Compliance Check (Criteria/  High Volume  Competency Detection
Category of Indicator: Choose one Standards/ Policy &  Problem Prone  Continuity  Respect & Caring
 Clinical Procedure)  Others, please  Effectiveness  Safety
 Organizational specify:  Efficacy  Timeliness
 Others, please specify:
Anticipated outcome: Target Sample and Sample Size (n): Data Collection Methodology: Choose one
Administer recommended prophylactic Patients who will undergo Knee Arthroplasty who  Retrospective  Prospective
antibiotic for patient with knee arthroplasty received antibiotic prior to surgery  Concurrent
surgery in all scheduled patients within 1 hour.
Indicator Formula: Numerator Statement: Denominator Statement:
Total number of surgical patients (knee Number of Surgical Patients (Knee Arthroplasty) with All selected surgical patients (Knee Arthroplasty) with no
arthroplasty) with prophylactic prophylactic antibiotics initiated within one hour prior evidence of prior infection and >= 18 years
antibiotics initiated within one (1) hour to surgical incision
prior to surgical incision x 100 Inclusion Criteria Exclusion Criteria Inclusion Criteria Exclusion Criteria
All selected surgical patients (Knee Patients who will undergo Knee N/A All cases of knee Patients with evidence of
Arthroplasty) with no evidence of Arthroplasty that received arthroplasty w/o prior infection.
prior infection and >= 18 years antibiotic within 1 hour administration of antibiotic Patients who are < 18
> 18 years years old.
Method of Data Collection: Choose one Frequency of Data Gathering: Choose one Frequency of Reporting & Analysis: Choose one
 Interview  Special Log / Tool  Daily  Quarterly  Daily  Quarterly
 Survey  Others, please specify:  Weekly  Yearly  Weekly  Yearly
 Chart Review Drug Card/Physician Order  Monthly  Monthly
Sheet
Target Value: Threshold Value: Data Reported as: Areas of Monitoring:
100% 80% Key performance indicator reported as line graph Surgical Ward

AHH-ADM.QM-008(06/17)NP Page 1 of 2
 Person(s) Responsible in Data Collection:
Ms. Elizabeth Miguel, Head Nurse of Surgical
Ward
Anticipated Reporting Time Period:
Every 1st week of the month
Prepared by:
Ms. Elizabeth Miguel
Head Nurse of Surgical Ward
AHH-ADM.QM-008(06/17)NP
Person(s) Responsible in Reporting and Analysis: Collaborative Department / Committee:
Dr. Muhammad Al-Gailani, Head of Surgery Department  Operating Room Committee
 Surgical Ward
 Quality Management Department
Results Disseminated to the Staff:
Results are disseminated thru:
 Teams, committees, and departmental meetings
 Email to the concerned department
 Bulletin boards to the concerned department
Reviewed by: Approved by:
Dr. Muhammad Al-Gailani Ms. Kamar Khalifa
Head of Surgery Department Quality Manager
Page 2 of 2