ARTICLE Reasons for Non-use of Proven Interventions for Hospital Inpatients:

Background: Recently, health care institutions have been using performance indicators to measure and improve quality of care. One such indicator, the Ideal Medication Intervention Index, reflects the rate of implementation of proven pharmacologic interventions, which studies have shown are underutilized. Identifying the reasons why proven interventions are underused is essential to determining how their rate of use can be improved. Objective: To characterize the reasons for non-use of proven interven-tions from the perspective of clinical pharmacists within the authors’ health care organization. Methods: A survey of all clinical pharmacists within the organization was conducted. The survey used standardized, case-based scenarios involving pharmacologic interventions known to improve health outcomes. Respondents were asked to rank potential reasons why a patient might not receive a proven intervention. Results: Of the 115 pharmacists invited, 53 (46%) participated in the survey. Most of the respondents practised on medical wards. The 2 most common reasons for non-use of proven interventions were a team preference to defer management of such issues to the outpatient care provider and issues related to workload. Conclusions: Clinical pharmacists revealed that their perceptions of priorities, communication with their interdisciplinary teams, and workload issues contributed to non-use of proven pharmacologic interventions among patients in their care. Efforts to increase the utilization of the proven clinical interventions studied here should focus on changing pharmacists ’ perceptions of priorities. Key words: quality assessment in health care, patient safety, knowledge translation, therapeutic omission, guideline adherence, care ga