Implementation of a Preoperative Risk Assessment for Post-Operative Nausea and Vomiting

Abstract

Problem: Currently 6.1% of post-surgical patients at this institution experience post-operative nausea and vomiting (PONV). Prophylactic measures for PONV are often based on provider preference, price, and availability contributing to significant variability in PONV prevention techniques. Since PONV risk ranges from patient to patient depending on risk factors such as gender, age, and type of anesthetic it is imperative preventative measures are individualized to each patient. Purpose: The purpose of this quality improvement project was to implement a preoperative risk assessment for adult surgical patients and evaluate its effectiveness in identifying patients at high-risk for PONV and guide anesthesia provider’s prophylactic interventions to decrease the incidence of PONV. Methods: Over 15-weeks a preoperative risk assessment was integrated into patient forms and filled out during intake. The anesthesia provider was expected to assess the risk score and administer preventative medications per the established PONV guideline. Data on compliance and post-operative nausea and vomiting rates was tracked throughout the implementation period. Results: The data reflected an average compliance of 96% and 90% with the documentation of PONV risk assessment on each patient’s perioperative record and identification of patients at high-risk for PONV during the first nine weeks of implementation. The anesthesia providers review of each patient’s risk score remained at an average of 54% during that time. Compliance with all three measures dropped significantly weeks 11 through 15 due to a clerical error which resulted in risk assessment not being included in the patient forms. During this time, the average compliance rate with risk assessment completion and high-risk identification was 18%. The compliance rate with the anesthesia provider’s review of the PONV score decreased to 17%. Conclusions: Due to the variable and limited nature of the compliance data, no statistically significant conclusions can be drawn. However, when compliance was at its highest, the rate of PONV trended down from a rate of 5% to 2.6% and as compliance dropped in November, PONV rates rose again to 4.5%.