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The effect of requesting a reason for non-adherence to a guideline in a long running automated reminder system for PONV prophylaxis
15 August 2016
Accepted: 19 January 2017
20 December 2017 (online)
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.
- 1 Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001; 345 (Suppl. 13) 965-970.
- 2 O’Reilly M, Talsma A, VanRiper S, Kheterpal S, Burney R. An anesthesia information system designed to provide physician-specific feedback improves timely administration of prophylactic antibiotics. Anesth Analg 2006; 103 (Suppl. 04) 908-912.
- 3 Rood E, Bosman RJ, van der Spoel JI, Taylor P, Zandstra DF. Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc 2005; 12 (Suppl. 02) 172-180.
- 4 Spring SF, Sandberg WS, Anupama S, Walsh JL, Driscoll WD, Raines DE. Automated Documentation Error Detection and Notification Improves Anesthesia Billing Performance. Anesthesiology 2007; 106 (Suppl. 01) 157-163.
- 5 Kooij FO, Vos N, Siebenga P, Klok T, Hollmann MW, Kal JE. Automated reminders decrease postoperative nausea and vomiting incidence in a general surgical population. BrJAnaesth 2012; 108 (Suppl. 06) 961-965.
- 6 Khalifa M, Zabani I. Improving Utilization of Clinical Decision Support Systems by Reducing Alert Fatigue: Strategies and Recommendations. Studies in health technology and informatics 2016; 226: 51-54.
- 7 Epstein RH. Postoperative nausea and vomiting, decision support, and regulatory oversight. Anesth Analg 2010; 111 (Suppl. 02) 270-271.
- 8 Topaz M, Seger DL, Slight SP, Goss F, Lai K, Wickner PG, Blumenthal K, Dhopeshwarkar N, Chang F, Bates DW, Zhou L. Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience. Journal of the American Medical Informatics Association: JAMIA 2016; 23 (Suppl. 03) 601-608.
- 9 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 7494 765.
- 10 Jung M, Riedmann D, Hackl WO, Hoerbst A, Jaspers MW, Ferret L, Lawton K, Ammenwerth E. Physicians’ perceptions on the usefulness of contextual information for prioritizing and presenting alerts in Computerized Physician Order Entry systems. BMC Med Inform Decis Mak 2012; 12: 111.
- 11 van der Sijs H, Baboe I, Phansalkar S. Human factors considerations for contraindication alerts. Stud Health Technol Inform 2013; 192: 132-136.
- 12 Phansalkar S, Edworthy J, Hellier E, Seger DL, Schedlbauer A, Avery AJ, Bates DW. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. J Am Med Inform Assoc 2010; 17 (Suppl. 05) 493-501.
- 13 Wickens CD, Dixon SR. The benefits of imperfect diagnostic automation: a synthesis of the literature. Theoretical Issues in Ergonomics Science 2007; 8 (Suppl. 03) 201-212.
- 14 Kooij FO, Klok T, Hollmann MW, Kal JE. Decision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. AnesthAnalg 2008; 106 (Suppl. 03) 893-898.
- 15 Kooij FO, Klok T, Hollmann MW, Kal JE. Automated reminders increase adherence to guidelines for administration of prophylaxis for postoperative nausea and vomiting. EurJAnaesthesiol 2010; 27 (Suppl. 02) 187-191.
- 16 Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91 (Suppl. 03) 693-700.
- 17 Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 20 282 (Suppl. 15) 1458-1465.
- 18 Apfel CC, Kranke P, Eberhart LH, Roos A, Roewer N. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002; 88 (Suppl. 02) 234-240.
- 19 Carlisle JB, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2006; 3: CD004125.
- 20 Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramer MR, Vander KC, Watcha M. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007; 105 (Suppl. 06) 1615-1628.