Patient Engagement to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery

Abstract

Problem and Purpose: Laparoscopic bariatric surgery patients are at high risk for postoperative nausea and vomiting (PONV) due to a combination of demographic and iatrogenic factors including age, sex, laparoscopic surgery of greater than one hour duration, stomach size reduction, and increased requirements for intraoperative hypnotics and opioids. The incidence of PONV after bariatric surgery ranges between 54% and 79% in the literature (Groene et al., 2019). PONV places patients at risk for postoperative surgical complications including wound dehiscence, dehydration, aspiration pneumonia, delayed recovery, and increased length of stay (LOS). In an 800-bed urban American teaching hospital, increased LOS due to PONV occurred in 6% of laparoscopic bariatric surgery patients between 2018 and 2019. The purpose of the project is to implement patient engagement techniques to reduce PONV in laparoscopic bariatric surgery patients and evaluate the results of the implementation. The goal is to eliminate increased LOS that occurs due to intractable PONV. Methods: Literature review and synthesis supported the idea that patient engagement via daily postoperative coaching by nurses combined with a paper-based self-management tool improves surgical outcomes. The practice changes include patient engagement via coaching, provision of a postoperative daily goal sheet, and collaboration with the primary nurse in the postoperative phase to establish and meet daily goals of care. Implementation strategies include patient education, educational inservices provided to nursing staff, reminders provided to nursing staff, and inclusion of a nurse champion among project stakeholders. Results: Results showed incomplete adoption of the intervention with only 10% of all postoperative daily goal sheets returned complete by the end of the implementation phase. Median incidence of LOS increased between the preimplementation phase and implementation phase, while documented PONV decreased and antiemetic administration was unchanged. No definitive association between the intervention and outcomes could be determined. Conclusions: Conclusions regarding the efficacy of the intervention could not be drawn. PONV remains a valuable target for reduction in this population worthy of future quality improvement initiatives.