Implementing the Baxter Animated Retching Faces Scale on a Pediatric Unit

Abstract

Background: Pediatric patients have a higher incidence of nausea and often receive less antiemetic treatment than adults. Nausea is often difficult to assess in the pediatric population as young children do not have the ability to effectively describe or rate nausea severity and thus only receive antiemetic treatment after they vomit. Pediatric patients who experience severe nausea and vomiting have increased morbidity and mortality, electrolyte abnormalities, dehydration, poor nutrition, stress, anxiety, and nonadherence to medications. Local Problem: A local community hospital’s pediatric unit lacked a standardized assessment of nausea, which resulted in variability in nursing assessment of nausea, leading to delayed detection and treatment. The purpose of the project was to implement and evaluate the use of the Baxter Animated Retching Face (BARF) scale in assessing nausea in pediatric patients aged 4–10 years. The aims of this project included obtaining nursing compliance with the use of the BARF scale to assess nausea in patients aged 4-10 years old and increasing early detection of nausea to allow for prompt antiemetic treatment. Implementation: The quality improvement project was implemented on the pediatric unit at a community hospital in Baltimore, Maryland. Prior to project implementation, data collection included chart audits to determine the monthly prevalence of nausea. Project implementation was conducted over a 14-week period. Education about the use of the BARF scale with the physician and nursing staff took place over the first 2 weeks. During weeks 3–14, the nurses used the BARF scale to assess nausea in children aged 4– 10 years old. Data were obtained pre- and post-implementation to compare the prevalence of nausea, the frequency of nausea documentation, and the frequency of antiemetic administration. Nursing staff were surveyed before and after BARF scale implementation on its feasibility and usability. Outcomes: A total of 138 patients met the inclusion criteria. The prevalence of nausea was similar pre and post-implementation of the BARF scale (7.4% vs. 8.6%). Nursing documentation of nausea assessment increased to almost 97%, PRN antiemetic usage increased from 72.4% to 87.4%, and nausea reassessment documentation remained low (20.8% vs. 14.4%). Approximately 95% of the nursing staff agreed that the BARF scale improved their nausea assessment, and 92.3% agreed that the BARF scale accurately identified the severity of nausea. Approximately 82% of nurses agreed that they were able to identify nausea in patients earlier with the BARF scale, and 94.9% of nurses would recommend the BARF scale to other pediatric units. The post-implementation survey results demonstrated that the BARF scale was an effective and feasible tool to assess nausea in this subset of hospitalized pediatric patients. Conclusion: The BARF scale is an easy-to-use screening tool that provides an objective measure of nausea in young children and may be useful for assessing nausea in a variety of pediatric settings.