Table 4 Interventions employed that did not influence guideline adherence
Author (year) and country | Study design and population | Intervention | Potential reasons for outcome |
|---|---|---|---|
Knox and Edye (2016) [80] Australia | Quasi-experimental (pre-post) | Education and increasing awareness without attempting to change practice  - Display of SAP guidelines for majority of the surgical procedures in surgical areas—mainly in theatre. Information present included the recommended drug, dose, time and duration  - Substantial advertising throughout the hospital site to raise general awareness of appropriate prescribing of antibiotics in all clinical areas | Knox and Edye [80] believe low uptake may be due to cognitive dissonance as the educational interventions used were passive in nature |
Not specified | |||
Nemeth et al. (2010) [81] USA | Quasi-experimental (pre-post) |  - Education of anaesthesia, surgical and nursing staff for a one month period  - Modification of pre-operative checklist to include confirmation of timely antibiotic administration | Nemeth et al. [81] believe that results were lower in the post-intervention group due to:  (a) Pre-operative verification not being conducted  (b) Verification being conducted incorrectly  (c) An inappropriate response or lack of response to verification Furthermore, pre-intervention compliance rates were quite high (90%) and sustained effects of intervention could not be observed due to short duration of post-intervention period (5 days) |
Anaesthesia, nursing and surgical staff | |||
Putnam et al. (2015) [82] USA | Quasi-experimental (pre-post) |  - Pre-operative checklist modification to ensure antibiotics are correctly administered  - CPOE used so that physicians can order antibiotics from pharmacy at any point prior to procedure  - Role delegation—anaesthetists responsible for administering antibiotics  - Attachment of guidelines to anaesthesia carts in theatre  - Revised guidelines disseminated electronically to all peri-operative staff | Putnam et al. [82] believe that outcomes were poor due to:  (a) Little effort in disseminating the CPOE  (b) Minimal education being provided on how to use the program  (c) Lack of monitoring of CPOE use after implementation  (d) Poor dissemination and implementation of the intervention cycles and guidelines |
Paediatric surgeons, anaesthesiologists and peri-operative staff |