1. Collaborative Initiatives on Improving the Quality of Post-Anesthesia Care by Decreasing Postoperative Nausea and Vomiting in the Post-Anesthesia Care Unit Julie L. Deel, MSN, RN-BC1 and Christopher A. Smith, DNP, CRNA2,3 1Clinical Informatics Team, Wellspan York Hospital,, York, PA 2 Anesthesia Associates of York, York, PA 3 Department of Anesthesia, Wellspan York Hospital, York, PA
Background
Postoperative nausea and vomiting (PONV) persists as a common experience for surgical patients,1 despite the pharmacological advances made over the past 150 years.2 Its presence decreases patient satisfaction,3 while increasing costs4 and complications.5
Identifying patients at risk for PONV and applying targeted multimodal antiemetic prophylaxis has repeatedly been shown to decrease institutional incidence.6-9
A paper based evidence based (EBP) project was undertaken at York Hospital (YH) to establish an incidence of PONV, implement preoperative PONV risk screening and targeted antiemetic prophylaxis.
The EBP project identified the historical incidence of PONV in the YH post-anesthesia care unit (PACU) to be 53.7% whereas the implementation group’s incidence was 12.6% (p < ). Compliance with the implementation protocol was calculated to be 75.8%.
With this large sample size, the law of large numbers suggests that these results are representative of the WellSpan Health (WSH) surgical population. Therefore, this evidence based (EBP) project identified a means to significantly decrease PONV throughout WSH surgical facilities.
Problem Statement
How can we incorporate preoperative PONV risk screening and targeted prophylaxis into the electronic medical record as a means to maintain these reductions, increase compliance and change culture?
Understanding the Problem
Historically inadequate PONV risk assessment, “Any problems with anesthesia in the past?”
Lack of standardized approach to antiemetic prophylaxis.
Patients at high risk for PONV require additional interventions.
Changing institutional culture is extremely CHALLANGING!
Action Plan
Goals:
Implement an electronic PONV screening process within the electronic health record (EHR).
Leverage current electronic documents and workflows for information sharing and decision support.
Audit PONV outcomes and compliance.
Present data and education throughout WellSpan Surgical facilities to improve patient outcomes.
Results
Six week snapshot after WSH “Go-Live”; Incidence of PONV and compliance with Targeted Prophylactic Recommendations.
Lessons Learned
Involve informatics early: project design, troubleshooting, implementation and evaluation.
Paper based pilots are an acceptable means to evaluate an EBP project’s efficacy prior to electronic implementation.
Think about WellSpan Health system-standard approach when implementing or suggesting change.
Where to go from here?
Continue roll-out throughout all WSH Facilities.
Integrate PONV risk assessment throughout all Nursing Units.
Identify electronic means to establish real-time PONV incidence metric.
Contact
Julie L. Deel, MSN, RN-BC –
Christopher A. Smith, DNP, CRNA –
Early PONV Prevention
Pre-Op Screening
Anesthesia Evaluation
Targeted Prophylaxis
Improved Patient Outcomes