Doctors learn new tricks, but do they remember them? Lack of effect of an educational intervention in improving Oxygen prescribing

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Background and objective:The ‘audit cycle’ is a fundamental part of improving clinical performance. For this to be effective, improvements made must be sustained. We observed that the prescription of Oxygen is often poor. Our aim was to audit Oxygen prescription before and after an educational intervention, and then again 4 years on. We hypothesized that improvements made immediately after the intervention would not be sustained over a longer period of time.Methods:Oxygen prescription was assessed in 102 inpatients between June and August 2009. Following this, an educational intervention to improve Oxygen prescription was staged. Oxygen prescription was then re-audited in a further 102 inpatients between September 2009 and February 2010. A third audit of 72 inpatients took place between February and May 2014.Results:One-way analysis of variance showed significant variance between audit groups (F 8.74, F-crit 4.26, P = 0.008). Post-hoc analysis with paired t-tests confirmed significant improvement in the rate of Oxygen prescription in the second audit (24.5–58.8%, P = 0.01), immediately after the intervention. Four years on in the third audit, there was significant deterioration in the rate of Oxygen prescription compared with the second audit (58.8–13.9%, P = 0.01).Conclusions:The rate of Oxygen prescription improves significantly after an educational intervention; however, this improvement is not sustained. This observation is likely reflected in a range of areas where the audit cycle is used to improve performance. It is important to be aware of this potential for regression to ensure that improvements are maintained over time.

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