Post Operative Nausea and Vomiting: A Quality Improvement Project

Abstract

Postoperative nausea and vomiting (PONV) management and prophylaxis is an important consideration for CRNAs. PONV is an adverse event affecting 30% of the general surgical population and up to 80% of high-risk patients. PONV is associated with longer stays in PACU and increased hospital admissions and health care costs. The purpose of this scholarly quality improvement project was to assess the CRNAs’ knowledge, preferences, and practices for managing PONV and whether or not they perceived a PONV quick refence guideline as a useful tool for their practice to aid in identifying high-risk patients, managing baseline PONV risks, and selecting strategies for prophylaxis and treatment. This project was completed at an ambulatory surgical center associated with a large academic medical center. A synthesis of the literature was performed and a short educational presentation along with a quick reference guide summarizing the synthesis was presented to CRNAs participants (n=7). Participants were asked to use the quick reference guide in their planning and management of PONV for a two-week period. Pre- and post-surveys were administered. Survey results indicated the CRNAs perceived the educational material and quick reference guide to be useful in the prevention and management of PONV. Post-survey results indicated increased familiarity with risk-based PONV prophylaxis, a key element of current consensus guidelines. Constraints on participants’ time was a key limitation. Future studies should focus on specific aspects of the current consensus guidelines for PONV management, such as the Apfel risk score or specific interventions for PONV, such as aromatherapy or acupuncture.