Barriers to implementing a surgical beta-blocker protocol

• Published in: Joint Commission journal on quality and patient safety Vol. 31; no. 11; p. 640
• Main Authors: Cantor, Michael N, Lavarias, Valentina, Lam, Steven, Mount, Lauren, Laskova, Violetta, Nakhamiyayev, Vadim, Bier, Yakov, Paiusco, Dino, Antonacci, Anthony C
• Format: Journal Article
• Language: English
• Published: Netherlands 01-11-2005
• Subjects: Academic Medical Centers; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - therapeutic use; Cardiac Output, Low - drug therapy; Clinical Protocols; Cohort Studies; Diffusion of Innovation; Dose-Response Relationship, Drug; Hospitals, Community; Humans; Postanesthesia Nursing; Prospective Studies; Retrospective Studies; Treatment Outcome
• ISSN: 1553-7250
• DOI: 10.1016/S1553-7250(05)31082-8

Experience with a quality improvement (QI) program undertaken to increase the use of beta-adrenergic blockade in at-risk patients at both a major academic medical center and a community hospital suggests barriers to implementation.
A retrospective and prospective cohort study was performed to establish the incidence and effectiveness of beta-blockade use pre- and postimplementation of a standardized screening tool and a major education program as part of a QI project. Data gathering involved a baseline phase pre-intervention; 6 weeks postintervention; and 3-6 months postintervention.
During phase I (baseline) 56% of eligible received beta-blockers, but targeted measures (a pre-induction heart rate < 70 or a systolic blood pressure [BP] < 110 mmHg) were achieved in only 11% of patients. Phase II saw a significant overall increase in beta-blocker administration (79%) and efficacy (50%). However, during phase III (3-6 months postimplementation), the rate of beta-blocker administration fell to 61% overall, while overall efficacy remained stable at 52%. Significant differences between the academic and community hospitals were observed throughout the study.
Implementation of a quality program for beta-blockade is significantly affected by the presence or absence of ongoing physician and staff education beyond the study period.