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

Correspondence to:

Fabian O Kooij
Academic Medical Centre, University of Amsterdam
Department of anaesthesia
PO Box 22660
1100 DD Amsterdam
Phone: +31 20 566 2533   
Fax: +31 20 697 9441   

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.


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Conflict of interest

Financial support for this study was provided by the authors’ employing institutions only. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.


Correspondence to:

Fabian O Kooij
Academic Medical Centre, University of Amsterdam
Department of anaesthesia
PO Box 22660
1100 DD Amsterdam
Phone: +31 20 566 2533   
Fax: +31 20 697 9441