Kooij Fabian O, Klok Toni, Hollmann Markus W, Kal Jasper E
Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Anesth Analg. 2008 Mar;106(3):893-8, table of contents. doi: 10.1213/ane.0b013e31816194fb.
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.
术后恶心呕吐（PONV）预防指南已广泛实施，但其有效性可能因依从性差而受限。我们推测使用电子决策支持（DS）系统将显著提高指南依从性。
我们地区教学医院所有接受择期手术患者的医疗信息在术前筛查门诊常规录入麻醉信息管理系统。我们科室的PONV预防指南将患者确定为“高危”，因此基于以下至少三个危险因素的存在而有资格接受PONV预防：女性、PONV或晕动病史、非吸烟状态以及术后预期使用阿片类药物。通过自动提醒，我们采用开-关-开设计研究DS对指南依从性的影响。在这三个研究阶段，我们查询了所有连续就诊于术前筛查门诊且有资格接受PONV预防的患者，并研究了正确开具预防药物的频率。
2005年11月至2006年6月期间，分别有1340例、2715例和1035例患者纳入对照组、DS组和DS后组。由于危险因素的强制数据录入，高危PONV患者的比例从对照组的28%分别增至DS组的32%和DS后组的31%。在对照组期间，所有高危患者中有38%接受了PONV预防。这一比例在DS期间增至73%，在DS后期间降至37%。
电子DS提高了高危PONV患者PONV预防处方的指南依从性。
