title: Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care--a cluster randomised study.
abstract: BACKGROUND
  Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention.
  
  
  METHODS
  The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention.
  
  
  RESULTS
  No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal.
  
  
  CONCLUSIONS
  The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN44819426.
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. ulrika.forberg@ki.se.|Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Elevhemmet H2:00, 171 76, Stockholm, Sweden. ulrika.forberg@ki.se.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Förberg
authors.affiliation: Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Unbeck
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.affiliation: Centre for Applied Biostatistics, Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Karolinska Institutet, ICHAR, Stockholm, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Elevhemmet H2:00, 171 76, Stockholm, Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ygge
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Ehrenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta; D002406:Catheterization, Peripheral / Q000451:nursing* / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000592:standards*; D010371:Pediatric Nursing / Q000592:standards*; D017410:Practice Guidelines as Topic; D017010:Reminder Systems / Q000592:standards*; D011795:Surveys and Questionnaires; D055815:Young Adult
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