Decision Support Increases Guideline Adherence for Prescribing Postoperative Nausea and Vomiting Prophylaxis

Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Anesthesia and analgesia (Impact Factor: 3.47). 04/2008; 106(3):893-8, table of contents. DOI: 10.1213/ane.0b013e31816194fb
Source: PubMed


Guidelines for postoperative nausea and vomiting (PONV) prevention are implemented widely but their effectiveness may be limited by poor adherence. We hypothesized that the use of an electronic decision support (DS) system would significantly improve guideline adherence.
Medical information of all patients undergoing elective surgery in our regional teaching hospital is routinely entered in an anesthesia information management system at the preoperative screening clinic. Our departmental PONV prevention guidelines identifies patients as "high-risk" and thus eligible for PONV prophylaxis based on the presence of at least three of the following risk factors: female gender, history of PONV or motion sickness, nonsmoker status, and anticipated use of postoperative opioids. Using automated reminders, we studied the effect of DS on guidelines adherence using an off-on-off design. In these three study periods, we queried for all consecutive patients visiting the preoperative screening clinic who were eligible for PONV prophylaxis and studied how often it was prescribed correctly.
Between November 2005 and June 2006, 1340, 2715, and 1035 patients were included in the control, DS and post-DS periods, respectively. As a result of mandatory data entry of risk factors, the percentage of high-risk PONV patients increased from 28% in the control period to 32% and 31% in the DS and post-DS periods, respectively. During the control period, 38% of all high-risk patients were prescribed PONV prophylaxis. This increased to 73% during the DS period and decreased to 37% in the post-DS period.
Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.

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Available from: Fabian Kooij, Feb 02, 2016
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    • "The symbiosis of a clearly identified anesthetic problem – PONV -, clearly established guidelines – PONV guidelines – and the existence of several drug combinations make this an ideal work field for intelligent DSSs. A recent study investigated the effect of such a DSS on guidelines adherence using an on-off design (Kooij et al., 2008). Fig. 8 presents the number of patients enrolled in this study. "

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    • "In particular, computer interventions which use reminders and automatic prompts have been found to be most successful [15]. The use of such computer based interventions has led to significantly increased adherence to guidelines and improvements in health-related outcomes across a variety of conditions and behaviours including RTI, constipation, croup, urticaria, urinary tract infections, and postoperative nausea and vomiting [16-18]. The use of these interventions has been demonstrated as effective for both prescribing behaviour [16] and preventive medical care [19]. "
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