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Table 4 Interventions employed that did not influence guideline adherence

From: Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review

Author (year) and country Study design and population Intervention Potential reasons for outcome
Knox and Edye (2016) [80]
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]
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]
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
  1. Abbreviations: CPOE computerised physician order entry, SAP surgical antimicrobial prophylaxis