Appl Clin Inform 2017; 08(01): 313-321
DOI: 10.4338/ACI-2016-08-RA-0138
Research Article
Schattauer GmbH

The effect of requesting a reason for non-adherence to a guideline in a long running automated reminder system for PONV prophylaxis

Fabian O. Kooij
1  Academic Medical Centre, Dpt. Anaesthesia, Amsterdam, The Netherlands
,
Toni Klok
2  OLVG hospital, Dpt. Anaesthesia, Amsterdam, The Netherlands
,
Benedikt Preckel
1  Academic Medical Centre, Dpt. Anaesthesia, Amsterdam, The Netherlands
,
Markus W. Hollmann
1  Academic Medical Centre, Dpt. Anaesthesia, Amsterdam, The Netherlands
,
Jasper E. Kal
2  OLVG hospital, Dpt. Anaesthesia, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received: 15 August 2016

Accepted: 19 January 2017

Publication Date:
20 December 2017 (online)

Summary

Background: Automated reminders are employed frequently to improve guideline adherence, but limitations of automated reminders are becoming more apparent. We studied the reasons for non-adherence in the setting of automated reminders to test the hypothesis that a separate request for a reason in itself may further improve guideline adherence.

Methods: In a previously implemented automated reminder system on prophylaxis for postoperative nausea and vomiting (PONV), we included additional automated reminders requesting a reason for non-adherence. We recorded these reasons in the pre-operative screening clinic, the OR and the PACU. We compared adherence to our PONV guideline in two study groups with a historical control group.

Results: Guideline adherence on prescribing and administering PONV prophylaxis (dexamethasone and granisetron) all improved compared to the historical control group (89 vs. 82% (p< 0.0001), 96 vs 95% (not significant) and 90 vs 82% (p<0.0001)) while decreasing unwarranted prescription for PONV prophylaxis (10 vs. 13 %). In the pre-operative screening clinic, the main reason for not prescribing PONV prophylaxis was disagreement with the risk estimate by the decision support system. In the OR/PACU, the main reasons for not administering PONV prophylaxis were: ‘unintended non-adherence’ and ‘failure to document’.

Conclusions: In this study requesting a reason for non-adherence is associated with improved guideline adherence. The effect seems to depend on the underlying reason for non-adherence. It also illustrates the importance of human factors principles in the design of decision support. Some reasons for non-adherence may not be influenced by automated reminders.