CS113 - The Development of an Evidence-Based Postoperative Nausea and Vomiting Protocol in the Perioperative Setting
Primary Author: Deborah Clark
Co-Author(s): Mary Marvin
Institution: OSF Saint Francis Medical Center, Peoria, IL
Contact Email: Debkc@msn.com
   
Purpose: Thirty percent of preoperative patients in general and up to 70% of patients at high risk suffer from postoperative nausea and vomiting (PONV). PONV can increase the patients's risk for aspiration, extended stay, increase financial burden to the patient and institution, increase the patient's discomfort, and decrease patient satisfaction. An evidence based protocol was developed to proactively promote a decrease or elimination of PONV in the perioperative setting.
Description: A collaborative perioperative team was formed. After reviewing extensive literature of the patient at risk for developing PONV (including surgical procedures, treatment modalities, and patient demographics) a risk scoring tool was developed. Points were assigned preoperatively for 8 identified risk factors such as patient gender, smoking history, type of surgical procedure, anesthesia type, procedure duration, use of post-op opioids, previous history of motion sickness or prior incidence of PONV. For each risk factor level identified, prophylactic strategies were defined, both pharmacological and nonpharmacological, that could be implemented to benefit the patient for a positive outcome. A physician order set was created to include the risk factor level, intravenous hydration, and medications categorized by drug class for utilization during the perioperative time frame. Prior to initiation, the protocol was approved by multiple hospital committees. Once approval was achieved, a copy of the order set, and risk and prophylaxis table were placed on every patient's chart for utilization by the anesthesia provider and the rest of the perioperative team.
Evaluation/Outcomes: Through utilization of the evidence based protocol for PONV, patients were identified at risk for developing PONV and were treated prior to anesthesia administration. Monthly audits occur by the perioperative nursing team with known positive outcomes reported accordingly. A positive outcome identified for the preoperative severe risk patient for development of PONV is the preprocedure placement of a Scopolamine 1.5 mg. dermal patch. During an 18 month period, all high risk patients interviewed postprocedure denied incidence of PONV.
   
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