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

Kooij, Fabian O.; Klok, Toni; Preckel, Benedikt; Hollmann, Markus W.; Kal, Jasper E.

doi:10.4338/aci-2016-08-ra-0138

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…The potential limitation of guidelines and a contributing factor to PONV is the low adherence to protocol by providers. 2,17 Several studies suggest the importance of including clinical decision tools or hard stops as automated reminders in the electronic medical record. The use of hard stops requires providers to specify a reason for nonadherence.…”

Section: Discussionmentioning

confidence: 99%

“…Factors such as increased workload, documentation error, and provider's disagreement with the validity of the risk score have been shown to result in providers' nonadherence and failure to appropriately document patients' risk scores. 17 The Society for Ambulatory Anesthesia (SAMBA) compiled evidenced-based guidelines to inform the current anesthesia practice on PONV management. 2,14 They recommend identifying patients at risk for PONV, identifying the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, the administration of two or more pharmacologic interventions for adults at high risk for PONV, ensuring that PONV prevention and treatment are implemented in the clinical setting, and the facilitation and use of multimodal PONV prevention guidelines and algorithms for surgical patients.…”

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting

Tabrizi¹,

Malhotra²,

Turnbull³

et al. 2019

Journal of PeriAnesthesia Nursing

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Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting

Tabrizi¹,

Malhotra²,

Turnbull³

et al. 2019

Journal of PeriAnesthesia Nursing

View full text Add to dashboard Cite

“…5 Face validity of the formative construct is more credible, as both risk factors and appropriate antiemetic prophylaxis are uncontroversial. 65 Both reliability and construct validity remain to be evaluated in future research.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

An Electronic Medical Record-Derived Individualized Performance Metric to Measure Risk-Adjusted Adherence with Perioperative Prophylactic Bundles for Health Care Disparity Research and Implementation Science

2020

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Background Health care disparity persists despite vigorous countermeasures. Clinician performance is paramount for equitable care processes and outcomes. However, precise and valid individual performance measures remain elusive. Objectives We sought to develop a generalizable, rigorous, risk-adjusted metric for individual clinician performance (MIP) derived directly from the electronic medical record (EMR) to provide visual, personalized feedback. Methods We conceptualized MIP as risk responsiveness, i.e., administering an increasing number of interventions contingent on patient risk. We embedded MIP in a hierarchical statistical model, reflecting contemporary nested health care delivery. We tested MIP by investigating the adherence with prophylactic bundles to reduce the risk of postoperative nausea and vomiting (PONV), retrieving PONV risk factors and prophylactic antiemetic interventions from the EMR. We explored the impact of social determinants of health on MIP. Results We extracted data from the EMR on 25,980 elective anesthesia cases performed at Penn State Milton S. Hershey Medical Center between June 3, 2018 and March 31, 2019. Limiting the data by anesthesia Current Procedural Terminology code and to complete cases with PONV risk and antiemetic interventions, we evaluated the performance of 83 anesthesia clinicians on 2,211 anesthesia cases. Our metric demonstrated considerable variance between clinicians in the adherence to risk-adjusted utilization of antiemetic interventions. Risk seemed to drive utilization only in few clinicians. We demonstrated the impact of social determinants of health on MIP, illustrating its utility for health science and disparity research. Conclusion The strength of our novel measure of individual clinician performance is its generalizability, as well as its intuitive graphical representation of risk-adjusted individual performance. However, accuracy, precision and validity, stability over time, sensitivity to system perturbations, and acceptance among clinicians remain to be evaluated.

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“…10,11 High-quality clinical practice guidelines on PONV management have been developed, and they recommend prophylaxis administration based on PONV risk stratification. 3,8,12 However, their actual effects on clinical practice are limited [13][14][15][16] because of several reasons.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

“…9,14,16,20,30 Some studies attempted to improve clinicians' compliance with PONV prophylaxis through different interventions, 13,15,20,[30][31][32][33] among which automated reminders were most commonly reported. 13,16,31,33,34 However, the real role about automated reminders remains controversial and is limited in PONV management. 9,33 Kooij found that after discontinuation of automated reminders, guideline adherence decreases back to control levels.…”

Section: F I G U R Ementioning

confidence: 99%

Pharmacist‐driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery

et al. 2020

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What is known and objective The incorrect or insufficient prophylaxis of postoperative nausea and vomiting (PONV) is common in practice. A clinical pharmacist‐led guidance team (CPGT) was established and included in general surgery teams. Objective This study aimed to evaluate the effects of the CPGT on the improvement of PONV and prophylaxis administration. Methods A prospective before‐after study was conducted on 156 female patients undergoing abdominal surgery at a Chinese tertiary teaching hospital from December 2016 to December 2017. A total of 82 patients were enrolled in the preintervention period, and 74 patients were included in the post‐intervention period. The CPGT established the evidence‐based criteria for prophylactic anti‐emetic administration and conducted interventions, including a review of medical records, provision of feedback, educational outreach, and dedicated support. Primary outcomes included the incidence of PONV within 24 hours of surgery, administered number of prophylactic anti‐emetics, and accuracy of the timing for prophylactic anti‐emetics. Outcomes were analysed by logistic regression or multivariable linear regression. Results and discussion After intervention, patients reported significantly less PONV (33.78% vs 56.10%; odds ratio [OR]: 0.29; numbers needed to treat [NNT]: 3.47), vomiting (29.73% vs 45.12%; OR: 0.42; NNT: 5.16) and nausea (31.08% vs 56.10%; OR: 0.24; NNT: 3.19) within 24 hours of surgery. The accuracy of the timing for prophylactic anti‐emetics significantly increased (OR: 3.66; P: .003). Anaesthesiologists administered increased numbers of prophylactic anti‐emetics (OR: 5.82; P < .001). The improvement of PONV did not decrease during the four‐month period after intervention (P: .639). What is new and conclusion The CPGT is a valuable service model to continuously improve PONV and optimize prophylaxis administration.

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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

Cited by 9 publications

References 20 publications

Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting

Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting

An Electronic Medical Record-Derived Individualized Performance Metric to Measure Risk-Adjusted Adherence with Perioperative Prophylactic Bundles for Health Care Disparity Research and Implementation Science

Pharmacist‐driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery

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