Implementing Guidelines to Manage Postoperative Nausea and Vomiting in Laparoscopic Surgery Patients

Abstract

Problem: Postoperative nausea and vomiting (PONV) is estimated to affect 30% of patients for 24 to 48 hours after general surgery, and up to 80% of patients who are considered high-risk. PONV causes distress, discomfort, and subsequent reduction in patient satisfaction. Furthermore, PONV can cause postoperative complications such as incisional stress, bleeding, fluid and electrolyte disturbances, and aspiration. In this community hospital, it was reported approximately 10% of surgical patients experience PONV. While this rate appears lower than the national average, PONV rates have been increasing during the past year and continue to rank high in measures of patient dissatisfaction, prompting administration and anesthesia staff to examine current practice. When baseline data was measured, the PONV rate was 44%. Purpose: The purpose of the doctor of nursing practice project was to reduce PONV among laparoscopic surgical patients in the perioperative setting by identifying patients at high risk for PONV and implementing an evidence-based prophylactic medication protocol based on risk levels. Methods: Anesthesia providers were educated about the incidence of PONV, common risk factors contributing to PONV, and the multimodal prophylactic medications to administer based on the PONV risk score. Data collection via chart audit was performed to evaluate PONV rates and the use of the prophylactic medication protocol by anesthesia providers. Results: 119 eligible patients were scheduled for laparoscopic surgery during project implementation. Documentation of the PONV risk assessment score in the preoperative note occurred 29% (n=34) of the time, and adherence to the prophylactic PONV medication protocol based on risk score was 29% (n=35). Despite the low adherence rate, PONV rates decreased to 25% during the 14-week period. Conclusions: Implementation and adherence to the evidence-based PONV guidelines is a