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.
Keywords
Automated reminders - decision support - PONV
