Improving the quality of post-anesthesia care: An evidence based initiative to

decrease the incidence of postoperative nausea and vomiting in the post-anesthesia

care unit

Background
Postoperative nausea and vomiting persists as a common experience for surgical
patients, despite the pharmacological advances made over the past 150 years. Its
presence decreases patient satisfaction, while increasing costs and complications.
Evidence in the literature suggests preoperative risk screening and targeted
prophylaxis decreases institutional incidence.

Methods
This project was a quality improvement, pre- and post-intervention design
consisting of elective surgery patients, made up of a historical comparison group
(N=3768; random sample n=95) and an implementation group (N=1139; random
matched sample n=109). The implementation group underwent preoperative risk
screening for postoperative nausea and vomiting utilizing the Apfel simplified risk
scoring method and targeted prophylaxis based upon the identified risk score. The
protocol was as follows: low risk (01 risk factors) received at least one antiemetic
intervention; moderate risk (2 risk factors) received at least two antiemetic
interventions; and high risk (34 risk factors) received at least three antiemetic
interventions. Measurements consist of the Apfel simplified risk score, incidence of
postoperative nausea and vomiting in the postoperative care unit and compliance
to protocol. Descriptive statistics were used for demographic data, Z-score and Chisquare (2) statistics were utilized. Correlations were calculated for compliance to
the protocol and incidence of PONV.

Results
The historical sample's incidence of PONV was 35.8% (n=34) whereas the
implementation sample's incidence was 11.9% (n=13) (p = 0.000). Correlations
were strong in both samples; the historical sample demonstrated less compliance as
PONV risk increased (r=0.95) and the implementation sample demonstrated greater
compliance with increased PONV risk (r=0.72). The overall compliance with the
targeted prophylaxis protocol in the implementation sample was calculated to be
85.3%, whereas the historical sample was 36.9% (p=0).

Conclusions
Preoperative identification of postoperative nausea and vomiting risk, risk
stratification, and compliant use of targeted prophylactic anti-emetic interventions
reduce the incidence of postoperative nausea and vomiting in the post-anesthesia
care unit. Use of proxy metrics are less reliable compared to direct measures.

MARJORIE A. ALVEZA
BSN IV Group I