Postoperative Nausea and Vomiting Reduction using the Apfel Screening and Treatment Tool

Abstract

Problem & Purpose: Postoperative nausea and vomiting is a complication that predisposes patients to numerous adverse events including dehydration, electrolyte disturbances, aspiration, and rehospitalization. The evidence-based Apfel risk tool can predict postoperative nausea and vomiting in high-risk patients and can guide anesthesia providers to administer prophylactic treatment. Screening patients undergoing high-risk surgical procedures is not routinely implemented at a university hospital which has resulted in elevated postoperative nausea and vomiting incident rates, approximately 3.4-5% when compared with the medical system’s average. This quality improvement project aims to implement the Modified Apfel risk tool to screen and prophylactically treat adult patients undergoing elective ear, nose, and throat surgeries at a university hospital. Methods: Adult patients scheduled for elective ear, nose, and throat cases were screened using the Modified Apfel tool and were treated based on their Apfel score. Compliance on screening patients using the tool and adherence to the prophylactic treatment guideline were collected daily. Additionally, data on patients who required antiemetic rescue treatment within 24 hours postoperatively was also collected daily. Run charts were used to analyze all data. Results: Fifteen weeks of data were collected and analyzed for 329 patients. A total of 135 patients (41%) were screened for postoperative nausea and vomiting with the Modified Apfel tool, 105 (78%) received treatment based on their score, and 124 patients did not receive rescue antiemetic treatment during the recovery period (92%). Overall, the implementation of the Modified Apfel tool guided anesthesia providers to administer prophylactic PONV treatment to ENT patients based on their Apfel score, thus reducing PONV in the recovery period. Conclusions: Although 100% provider compliance of screening patients with the risk tool was not achieved, the findings suggest that the implementation of the Modified Apfel tool and treatment guideline may decrease the use of rescue antiemetics in the recovery period. Therefore, utilizing the Apfel tool and treatment guideline to improve postoperative nausea and vomiting rates are feasible interventions that could be implemented in the clinical setting.