Management of Postoperative Nausea and Vomiting: A Quality Improvement Project

Abstract

Postoperative nausea and vomiting (PONV) is a complex side effect of general anesthesia affecting 30% of the general surgical population and up to 80% of high-risk patients. Prevention and management of PONV are crucial roles of the CRNA, beginning in the preoperative setting and continuing through the postoperative setting. Currently, there is a lack of standardized guidelines for PONV management among departments. The purpose of this scholarly project was to assess the CRNAs’ knowledge, preferences, and practices for managing PONV, and whether they perceived the PONV Quick Reference Guide as a useful tool for their practice to aid in identifying high-risk patients, managing baseline PONV risks, and selecting strategies for prophylaxis/rescue treatment. An educational PowerPoint, summative PONV Quick Reference Guide, and endorsed guidelines as well as pre- and post-project implementation surveys were shared with CRNAs participating in the quality improvement project. Upon completion of the two-week implementation period, during which CRNAs utilized the educational PowerPoint and PONV Quick Reference Guide, participants completed the post-project implementation surveys allowing for analysis when compared to pre-project implementation surveys. Participants perceived increased familiarity and competency with the ASRS, recommended having an implemented PONV management protocol, and perceived a quick reference guide for the management of PONV as useful. Suggestions for future applications include in-person education or interactive learning modules, increased availability of physical materials, and limiting education to practice-relevant information.