自动化提醒可提高术后恶心呕吐预防用药指南的依从性。

Automated reminders increase adherence to guidelines for administration of prophylaxis for postoperative nausea and vomiting.

机构信息

Department of Anaesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

出版信息

Eur J Anaesthesiol. 2010 Feb;27(2):187-91. doi: 10.1097/EJA.0b013e32832d6a76.

DOI:10.1097/EJA.0b013e32832d6a76

PMID:19478673

Abstract

BACKGROUND AND 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).

CONCLUSION

Decision support is effective in improving administration and timing of PONV prophylaxis medication. After withdrawal of decision support, adherence decreased to predecision support levels.

摘要

背景与目的

正确识别术后恶心呕吐（PONV）高危患者、预防性开具 PONV 处方和正确给药对于 PONV 的有效预防至关重要。这一点已被全球指南的制定所认可。我们研究了在全身麻醉期间引入针对患者的自动提醒对 PONV 预防药物及时给药的影响。

方法

在术前筛查诊所就诊时，确定 PONV 高危患者并开具 PONV 预防处方。为了研究针对患者的决策支持（弹出窗口提醒麻醉师已为该特定患者开具 PONV 预防药物）对 PONV 药物及时给药的影响，我们查询了我们的数据库，以提取连续三个时间段（决策支持前 6 周[对照组]、决策支持期间 12 周和决策支持停止后 6 周[决策支持后]）的所有患者的数据，并研究了 PONV 预防药物正确给药的频率。

结果

2005 年 11 月至 2006 年 5 月，分别有 1727、2594 和 1331 例择期手术患者在对照组、决策支持组和决策支持后组就诊。在对照组中，236 例接受全身麻醉的患者计划接受 PONV 预防。其中，93 例（39%）在正确的时间框架内接受了地塞米松和格拉司琼。在决策支持期间，这一比例增加到 591 例中的 464 例（79%），而在决策支持后组中，这一比例下降至 243 例中的 99 例（41%）（P<0.001）。