Risk Factors and Nausea Prophylaxis in the Gynecological (GYN), Urological, and Ear, Nose and Throat (ENT) Surgical Population at an Ambulatory Surgery Center

Doctoral Candidate Name: Rebekah P. Ross
Program: Doctor of Nursing Practice
Defense Date and Time: December 2, 2022 – 10:00 AM
Defense Location: UNCC College of Health & Human Services – Room 406
Committee chair’s Name: Stephanie Woods
Committee Members: Katie Shue-Mcguffin, Karen Lucisano, Shanti Kulkarni, Jenny Dhingra
Abstract:

ABSTRACT
REBEKAH P. ROSS. Risk Factors and Nausea Prophylaxis in the Gynecological (GYN), Urological, and Ear, Nose and Throat (ENT) Surgical Population at an Ambulatory Surgery Center
(Under the Direction of DR. STEPHANIE WOODS)

This is a quality improvement (QI) project that examines post-operative nausea and vomiting (PONV) prophylaxis and PONV in the Post Anesthesia Care Unit (PACU) in an ambulatory surgery center of a large hospital system. PONV causes negative health sequelae, increases the financial burden, and decreases patient satisfaction. The clinical question for this QI project is: In the population of Gynecological (GYN), Urological, and Ear, Nose, and Throat (ENT) surgical patients 18 years and older, undergoing surgery at an ambulatory surgery center, how does patient, anesthetic, and surgical risk factors for PONV and the delivery of antiemetics affect the incidence of PONV? Data related to patient, anesthetic, and surgical risk factors, and PONV in the PACU was collected via chart review. Data analyses were conducted to determine patient, anesthetic, and surgical risk factors, and PONV prophylaxis administration. Apfel score was positively associated with an increase in actual antiemetics given. Patient risk factors (Apfel score), anesthesia risk factors, and surgical risk factors did not predict PONV. A little over half of the patients received PONV prophylaxis consistent with the Fourth Consensus Guidelines. Lastly, over 80% of high-risk patients (Apfel > 2) are receiving an inadequate amount of antiemetics. Education to improve anesthesia providers knowledge on the Apfel scoring system and Fourth Consensus Guidelines is recommended to improve adherence.
Keywords: PONV, gynecologic, ENT, urologic, surgery, ambulatory surgery centers, anesthesia, PACU