title: Automated reminders increase adherence to guidelines for administration of prophylaxis for postoperative nausea and vomiting.
abstract: OBJECTIVE
  Correct identification of patients at high risk for postoperative nausea and vomiting (PONV), prescription of PONV prophylaxis and correct administration of medication are all important for effective PONV prophylaxis. This has been acknowledged by development of guidelines throughout the world. We studied the effect of introducing patient-specific automated reminders on timely administration of PONV prophylaxis medication during general anaesthesia.
  
  
  METHODS
  During the visit to the preoperative screening clinic, patients at high risk for PONV were identified and PONV prophylaxis was prescribed. To study the effect of patient-specific decision support [a pop-up window reminding the (nurse) anaesthetist that PONV prophylaxis had been prescribed for this particular patient] on the timely administration of PONV medication, we queried our database to extract data on all patients for three consecutive periods: 6 weeks before decision support (control), 12 weeks during decision support and 6 weeks after discontinuation of decision support (postdecision support) and studied how often PONV prophylaxis was administered correctly.
  
  
  RESULTS
  Between November 2005 and May 2006, 1727, 2594 and 1331 patients presented for elective surgery in the control, decision support and postdecision support periods, respectively. In the control period, 236 patients receiving general anaesthesia were scheduled to receive PONV prophylaxis. Of these, 93 (39%) received both dexamethasone and granisetron in the correct timeframe. This increased to 464 (79%) out of 591 patients in the decision support period and decreased back to 99 (41%) out of 243 patients in the postdecision support period (P < 0.001).
  
  
  CONCLUSIONS
  Decision support is effective in improving administration and timing of PONV prophylaxis medication. After withdrawal of decision support, adherence decreased to predecision support levels.
authors.affiliation: Department of Anaesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Fabian O
authors.initials: FO
authors.lastname: Kooij
authors.forename: Toni
authors.initials: T
authors.lastname: Klok
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.forename: Jasper E
authors.initials: JE
authors.lastname: Kal
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D016208:Databases, Factual; D003661:Decision Support Techniques; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D017829:Granisetron / Q000008:administration & dosage / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000932:Antiemetics; D003907:Dexamethasone; D017829:Granisetron