1. An Evidence Based Practice (EBP) Project to Affect the Incidence of Post-Operative Nausea and Vomiting (PONV) in a Tertiary Care Post–Anesthesia Care Unit (PACU) Christopher A. Smith, CRNA, MSN, DNP Student York College of Pennsylvania, York, PA 17403
Implementation
EBP project will be implemented September 2014.
The Apfel simplified risk scoring tool will be implemented in the pre-hospital testing unit.
A standardized anesthetic approach for each risk category will be implemented.
Results
The project will span 14 weeks during which time baseline measurement, implementation of the screening tool, and evaluation of the outcomes population of adult surgical patients admitted for elective surgery at a local teaching hospital.
Conclusions & Implications
Practitioners have long accepted PONV as an inevitable result of the surgical process; however, evidence-based, patient-centered care to reduce the incidence of PONV benefits the patient and may also improve the patient experience.
Acknowledgements
This project is supported by Anesthesia Associates of York, Wellspan Health , and The Graduate Nursing Department at York College of Pennsylvania. A special thank you to Kim Fenstermacher, PhD, CRNP and Deb Barton MS, RN for their support and encouragement with this presentation.
Contact
Christopher A. Smith, CRNA,
Practice Question
In post-operative patients, does the use of a screening tool and targeted prophylactic regimen reduce the incidence of PONV compared to rescue medication?
Objectives
1. To define the impact of PONV on patient and hospital outcomes.
2. To describe the utility of a evidence-based screening tool for PONV risk assessment.
3. To describe a patient centered multi modal approach to mitigate PONV risk.
Background
PONV is of significant concern for patients, nurses and the entire health care system.
Gan (2007) reports the incidence of PONV to be approximately 1/3 of all surgical patients in the United States.
The CDC (2014) reports >51 million in-patient surgeries in and >57 million out-patient surgeries in 2006.
That equates to roughly 35 million patients per year experiencing PONV.
Gold (1989) and Williams (2004) report that 17% of outpatients that experience PONV require admission to the hospital.
Conway (2009) found that patients experiencing PONV may remain in the PACU for an additional 60 – 180 minutes.
Dzwonczyk et al. (2012) reported that patients rank PONV in the top 5 most undesirable outcomes of surgery.
McKean et al. (2006) reported that patients fear vomiting more than pain.
Hambridge (2012) report PONV associated complications as bleeding, dehydration, dehiscence, aspiration, electrolyte imbalance, esophageal rupture, subcutaneous emphysema and bilateral pneumothoraxes.
Methods
The Johns Hopkins EBP Model will be utilized.
A comprehensive search was conducted CINAHL, MEDLINE with full text and Cochrane Database
Search terms: postoperative nausea and vomiting; risk assessment and prediction, prophylaxis regimens in PONV.
Articles met the inclusion criterion if they contained information pertaining to PONV risk assessment, risk stratification, predictive tools or models and / or PONV prophylaxis.
Materials
The Apfel simplified risk assessment tool was identified as a means to categorize patients as Low, Moderate or High risk for PONV.