Department of Anesthesiology, Vanderbilt University Medical Center, United States of America.
Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, the Netherlands.
J Clin Anesth. 2023 Jun;86:111081. doi: 10.1016/j.jclinane.2023.111081. Epub 2023 Feb 20.
Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes.
Single center, prospective observational study between January 1, 2015, and June 30, 2017.
Perioperative care at a university-affiliated tertiary care center.
57,401 adult patients who received general anesthesia in a non-emergency setting.
A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores.
Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured.
Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p < 0.001) improvement in the compliance of PONV medication administration along with an 8.7% (95% CI, 7.1% to 10.2%, p < 0.001) reduction in PONV rescue medication administration in the PACU. However, there was no statistically or clinically significant reduction in the prevalence of PONV in the PACU. The prevalence of PONV rescue medication administration decreased during the Intervention Rollout Period (odds ratio 0.95 [per month]; 95% CI, 0.91 to 0.99; p = 0.017), and during the Feedback with CDS Recommendation Period (odds ratio, 0.96 [per month]; 95% CI, 0.94 to 0.99; p = 0.013).
PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.
大量证据表明，病历现代化和大量可用数据并未弥合推荐护理和实际护理之间的差距。本研究旨在评估临床决策支持（CDS）与反馈（事后报告）结合使用，以提高术后恶心和呕吐（PONV）药物管理的依从性和 PONV 结果。
2015 年 1 月 1 日至 2017 年 6 月 30 日期间的单中心前瞻性观察研究。
大学附属三级保健中心的围手术期护理。
57401 名在非紧急情况下接受全身麻醉的成年患者。
包括对患者的 PONV 发生情况进行个体提供者的事后报告，然后通过术前每日病例电子邮件提供定向 CDS，根据患者的 PONV 风险评分提供治疗性 PONV 预防建议。
测量 PONV 药物建议的依从性以及医院 PONV 发生率。
在研究期间，PONV 药物管理的依从性提高了 5.5%（95%CI，4.2%至 6.4%；p<0.001），PACU 中 PONV 救援药物管理减少了 8.7%（95%CI，7.1%至 10.2%；p<0.001）。然而，PACU 中 PONV 的发生率并没有统计学或临床上显著降低。在干预实施期间（每月风险比 0.95[每月]；95%CI，0.91 至 0.99；p=0.017）和反馈与 CDS 建议期间（每月风险比 0.96[每月]；95%CI，0.94 至 0.99；p=0.013），PONV 救援药物管理的发生率下降。
CDS 与事后报告相结合，可适度提高 PONV 药物管理的依从性；然而，PACU 中 PONV 的发生率并没有改善。
