1. Self-Reported Adoption of Evidence-Based Guidelines for the Prevention/Management of PONV/PDNV Vallire D. Hooper PhD, RN, CPAN, FAAN Asheville, NC

2. Acknowledgements Dissertation committee: –Lucy Marion PhD, RN, FAAN; Richard Campbell PhD; Donna Fick PhD, APRN-BC, FGSA, FAAN; Alfred Lupien PhD, CRNA, FAAN; Marita Titler PhD, RN, FAAN This project was supported by grants from the following: –American Society of PeriAnesthesia Nurses (ASPAN) –STTI (Beta Omicron) –AHRQ (R36HSO17386) 2

3. Problem Postoperative/postdischarge nausea & vomiting (PONV/PDNV) impacts 1/3 of surgical patients annually –Approximately 75 million patients Strongest predictor of prolonged hospital stay and unanticipated hospital admission Is the most commonly reported patient fear prior to elective surgery –Viewed as more debilitating than postoperative pain –Feared more than death Patients are willing to pay $80 to $100 out of pocket to prevent Apfel et al (2004, 2012), Crichton & Edmunds (2006), Diez (1998), Gan et al (2001), Macario et al (1999), Odom-Forren & Moser (2005)

4. Problem Evidence-based clinical practice guidelines (CPG) are recognized by the AHRQ & the IOM as a key component in the provision of safe, quality patient care CPG have been developed to guide the prevention/management of PONV/PDNV –Degree of adoption of these guidelines in not known 4 AHRQ (2005, 2008), ASPAN (2006), Gan et al (2007), IOM (2001)

5. Purpose The purpose of this secondary data analysis was to determine the degree of self-reported adoption of the PONV/PDNV guidelines by perianesthesia nurses and anesthesia providers Research questions: –What is the overall self-reported awareness of the PONV/PDNV guideline? –What is the self-reported adoption of Phase specific recommendations of the PONV/PDNV guideline? –What demographic factors are most highly correlated to self-reported CPG adoption?

6. Research Design: Primary Study Cross-sectional, descriptive, exploratory design using a web-based survey –Administered using Dillman (2007) methodology over an 8 week period Sample –Stratified random sample of 3200 members of the American Society of PeriAnesthesia Nurses (ASPAN) (RN sample), American Association of Nurse Anesthetists (AANA) (CRNA sample), and the Society for Ambulatory Anesthesia (SAMBA) (MD sample) 6

7. Results

8. Response Rates 8

9. Response by Group 9

10. Demographics 10

11. Highest Level of Education Completed

12. Overall Self-Reported Adoption 12

13. Overall Self-Reported Adoption

14. Phase Specific Adoption Total Respondents

15. Phase Specific Adoption Scores

16. Preadmission/Pre-op Recommendations

17. Phase I & II Recommendations

18. Anesthesia Planning Recommendations

19. Anesthesia Practice Recommendations Anesthesia Recommendation Means Recommendations vs. Practice 19

20. Conclusion Overall guideline awareness & self-reported adoption of phase-specific recommendations was higher than expected –No factors significantly correlated to adoption Limitations –Small sample size –Self-report may not be reflective of actual practice Recommendations –Point-of-care studies examining actual adoption in practice and impact on patient outcome

21. References Agency for Healthcare Research and Quality. (2005). Director's Welcome Retrieved February 6, 2008, from http://www.ahrq.gov/fund/dirwelcome.htmhttp://www.ahrq.gov/fund/dirwelcome.htm Agency for Healthcare Research and Quality. (2008). AHRQ annual highlights 2008 Retrieved April 9, 2009, from http://www.ahrq.gov/about/highlt08.pdfhttp://www.ahrq.gov/about/highlt08.pdf American Society of PeriAnesthesia Nurses. (2006). ASPAN's evidence-based clinical practice guideline for the prevention and/or management of PONV/PDNV. Journal of Perianesthia Nursing, 21, 230-250. Apfel, C. C., Kranke, P., & Eberhart, L. H. (2004). Comparison of surgical site and patient's history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia, 59(11), 1078-1082. Apfel, C. C., Philip, B. K., Cakmakkaya, O. S., Shilling, A., Shi, Y.-Y., Leslie, J. B.,... Kovac, A. (2012). Who Is at Risk for Postdischarge Nausea and Vomiting after Ambulatory Surgery? Anesthesiology, 117(3), 475-486. Crichton, T., & Edmonds, M. (2006). Developing an Evidence-Based Guideline: Prophylaxis of Post-Operative Nausea and Vomiting Retrieved October 6, 2009, from http://www.informatics.adelaide.edu.au/research/Preop/ME-EBGLPonv.html http://www.informatics.adelaide.edu.au/research/Preop/ME-EBGLPonv.html

22. References Diez, L. (1998). Assessing the willingness of parents to pay for reducing postoperative emesis in children. Pharmacoeconomics, 13(5 Pt 2), 589-595. Gan, T. J., Meyer, T. A., Apfel, C. C., Chung, F., Davis, P. J., Habib, A. S.,... Society for Ambulatory, A. (2007). Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting.[see comment]. Anesthesia & Analgesia, 105(6), 1615-1628. Gan, T. J., Sloan, F., Dear, G. L., El-Moalem, H. E., & Lubarsky, D. A. (2001). How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesthesia & Analgesia, 92(2), 393-400. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Macario, A., Weinger, M., Carney, S., & Kim, A. (1999). Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesthesia & Analgesia, 89(3), 652-658. Odom-Forren, J., & Moser, D. K. (2005). Postdischarge nausea and vomiting: A review of current literature. Ambulatory Surgery, 12(2), 99-105.