• D L Phipps, P C W Beatty, D Parker, C Nsoedo, and G H Meakin.
• School of Medicine, University of Manchester, Imaging Science and Biomedical Engineering, Stopford Building, Oxford Road, Manchester M13 9PL, UK. denham.phipps@vodafone.net
• Br J Anaesth. 2009 Jun 1;102(6):768-74.

BackgroundWith 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.MethodsA 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.ResultsIn 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.ConclusionsAnaesthetists' 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.

This article appears in the collection: Decision Making in Anaesthesia & Critical Care.

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