Purpose: The quality improvement (QI) project implemented a postoperative nausea and vomiting (PONV) risk screening tool and introduced a risk-tailored prophylactic guideline to identify patients at risk for PONV and aimed to minimize PONV adverse events.
Design: This project represents the initial PDSA (Plan-Do-Study-Act) cycle for quality improvement with use of a pre-post design with two independent groups designed to compare PONV rates before and after implementation of an Apfel Simplified Risk Score screening and prophylactic guideline intervention.
Methods: The project implemented the screening of patient PONV risk using the Apfel Simplified Risk Score and a combination antiemetic drug class prophylactic guideline for adult patients undergoing elective same-day surgery procedures. An online education module was provided to anesthesia professionals and was reviewed in-person with the relevant anesthesia professional team prior to surgery. Pre-implementation (N=107) PONV outcomes were collected. Data collected from a retrospective chart review was used to compare pre- and post-implementation PONV rates (N=96) and determine post-implementation anesthesia professional adherence to guideline recommendations.
Findings: Forty percent of screened patients were identified as having an increased PONV risk with an Apfel Simplified Risk Score of 3 or 4. The PONV rates for the pre-group (19.6%) and post-group (22.9%) did not significantly differ (P=.5567). Anesthesia professional adherence to administration of the recommended number of antiemetic drug classes was 89.6%. A Spearman point-biserial correlation analysis indicated a significant positive relationship between Apfel Simplified Risk Score and PONV onset in the post-group (r=0.21, P=.0428).
Conclusions: The Apfel Simplified Risk Score and prophylactic guideline increased identification of patients at risk for PONV but did not affect PONV rate despite a high anesthesia professional adherence to the guideline recommendations.
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The Royal Melbourne Hospital, Melbourne, VIC, Australia.
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Article Synopsis
- The study aimed to evaluate how well existing tools predict postoperative nausea and vomiting (PONV) risk in liver cancer patients undergoing hepatectomy, addressing the need for effective prevention strategies.
- It involved assessing 214 patients using the Apfel and Koivuranta risk scores, revealing that neither score performed well in predicting PONV, with low ROC areas and poor calibration.
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