• Implementation of Postoperative Nausea and Vomiting Screening and Referral Practice Change

      Bilbao, Maryanne E.; Franquiz, Renee (2022-05)
      Problem: Postoperative nausea and vomiting (PONV) is defined as nausea and vomiting experienced 24-48 hours after surgery and can have as high as an 80% incidence rate. This leads to patient dissatisfaction and physical injury (such as esophageal injuries, wound dehiscence, and pulmonary aspiration). Risk factors of PONV include patient specific factors (being female, non-smoker or having a history of nausea and vomiting), surgical factors (certain surgeries such as breast or laparoscopic surgeries) and anesthesia factors (use of anesthetic gas, opioids, and duration of anesthesia). The project site has an exceedingly high PONV rate affecting 41.5% of patients undergoing laparoscopic gynecologic and breast surgeries. Identifying patient risk factors can inform PONV prevention for each patient population. Purpose: The purpose of this Quality Improvement project is to implement a preoperative PONV screening process to quantify PONV risk in patients receiving laparoscopic gynecologic and breast surgeries and refer for intraoperative management. Methods: The Apfel postoperative nausea and vomiting screening tool is a valid, evidence-based tool used in practice to quantify the PONV risk factors of gender, smoking status, postoperative use of opioids and history of nausea and vomiting. A new practice was implemented to screen patients undergoing elective breast and laparoscopic surgeries using the Apfel screening and refer patients for risk-stratified postoperative nausea and vomiting interventions. Results: A total of 177 patients were eligible for this QI project with 109 patients receiving breast surgery and 68 receiving laparoscopic gynecologic surgery. Apfel screening adherence among anesthesia providers is 56% with a referral rate of 80% to the intraoperative PONV protocol. Postoperative nausea and vomiting incidence declined from 41.5% to 36%. Conclusion: Preoperative Apfel screening is an effective and feasible practice change to guide patient specific prophylaxis for PONV that is supported by the literature and may reduce the need for antiemetic rescue medication in the post anesthesia care unit.
    • Nurse-Led Peer Facilitated Diabetes Prevention and Early Intervention Program

      Adejumo, Oluremi Abiodun; Bode, Claire (2019-05)
      BACKGROUND: Prediabetes, an antecedent to type 2 diabetes (T2D) - the 7th leading cause of death and disability in the U.S., poses a greater impact on marginalized populations. The risk factors include excessive weight, unhealthy eating habits, sedentary lifestyle, and smoking. Diabetes prevention program (DPP) lifestyle intervention can delay or halt the progressions of prediabetes to T2D. PROBLEM: The formerly homeless men in an inner-city residential employment center on the East Coast of the U.S. exhibited high rates of risk factors for T2D: tobacco use (83%), obesity (54%), pre-hypertension (39%), hypertension (14%), and family history of diabetes (42%). OBJECTIVES: This nurse led DPP project implemented and evaluated a peer facilitation approach for reduction of T2D risks among the formerly homeless men in this employment program. METHODS: Five formerly homeless men who were previously trained as diabetes prevention lifestyle coaches (“peer facilitators”) using the Group Lifestyle Balance curriculum delivered twelve (12) weeks of the DPP core interventions to their peers. Each peer kept weekly logs of dietary and smoking habits, the number of times per day that they replaced sugar-sweetened beverages (SSB) with water, and physical activity. Data analyses of changes in all variables were conducted using self-reported data from the participants’ weekly logs and statistical significance was analyzed using the paired t-tests. RESULTS: All these men (N=15) met the required inclusion criteria of having a score of five (5) or higher on the American Diabetes Association (ADA) risk assessment test (mean=5.53; SD=0.74; range=5-7 of a maximum 11 points) combined with being aged 18 years or older. At baseline, most of these men were smokers (73%) and had a family history of diabetes (73%). Data from the participants’ weekly logs for weeks 1 to 12 showed statistically significant changes in behavioral modifications except for physical activity between weeks 1 and 4 (p=0.5). However, there was a significant increase in the participants’ mean number of days for physical activity from week 1 to week 8 (p=0.007) and week 1 through week 12 (p<0.001). Significant reductions were also observed in participants’ mean weights from weeks 1 to 12 (p<0.001). CONCLUSION: Implementation of a nurse-led, peer-facilitated, diabetes prevention in formerly homeless men significantly reduced their risks for T2D; fostered strong relationships among peers; increased program’s relevance and participants’ attendance, as well as provided enormous opportunities for these facilitators to seek employment in other community-based support programs. As well-informed community leaders, these men can also reach numerous other, often hard-to-reach individuals in their network of family and friends. Thus, commitments from local partners will be extremely valuable for sustainability and future evaluations of this tailored, community-based, quality improvement project.