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BJA Advance Access originally published online on April 27, 2009
British Journal of Anaesthesia 2009 102(6):768-774; doi:10.1093/bja/aep082
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Motivational influences on anaesthetists’ use of practice guidelines

D. L. Phipps1,*, P. C. W. Beatty1, D. Parker2, C. Nsoedo1 and G. H. Meakin1,3

1 School of Medicine
2 Manchester Business School, University of Manchester, Imaging Science and Biomedical Engineering, Stopford Building, Oxford Road, Manchester M13 9PL, UK
3 University Department of Anaesthesia, Central Manchester and Manchester Children’s Hospitals NHS Trust, Manchester, UK

* Corresponding author. E-mail: denham.phipps{at}vodafone.net

Background: With the proliferation of practice guidelines in anaesthesia comes the possibility that anaesthetists may, during the course of their work, commit ‘violations’ (actions that are not intended to cause harm to patients, but that deviate from guidelines). These may have a long-term impact on patient safety, and so there is a need to understand what makes anaesthetists decide to follow or deviate from guidelines.

Methods: A questionnaire on the use of guidelines was completed by 629 College Fellows. This presented three anaesthetic scenarios, each of which involved a deviation from a guideline, and asked respondents to rate their beliefs about the likely outcome of the violation, the level of social approval they would have for violating, the amount of control they would have over violating, and the practice of their peers with regard to violating.

Results: In all three scenarios, beliefs about the outcome of violating and the amount of control over violating predicted respondents’ self-reported likelihood that they would commit the violation. In two scenarios, beliefs about the practice of peers predicted violating. Level of social approval predicted violating in one scenario only.

Conclusions: Anaesthetists’ decisions to follow or deviate from guidelines are influenced by the beliefs they hold about the consequences of their actions, the direct or indirect influence of others, and the presence of factors that encourage or facilitate particular courses of action.

Keywords: education; risk; safety


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