This is a quality improvement (QI) project that examines post-op nausea and vomiting prophylaxis (PONV) and PONV in the Post Anesthesia Care Unit (PACU) in a Suburban hospital that is part of a large hospital system. Post operative nausea and vomiting (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, how do patient, anesthetic, and surgical risk factors for PONV and the delivery of antiemetics affect the incidence of PONV in a Suburban Hospital setting?
Data related to patient anesthesia, and surgical risk factors, and PONV in the PACU was collected via chart review. Data analysis was conducted to determine patient, anesthetic, and surgical risk factors, and PONV prophylaxis administration. The relationship between the Apfel score and the number of antiemetic medications administered during the intraoperative period was determined to not be predictive of antiemetic administration. Patient, anesthetic, and surgical risk factors did not predict PONV. The percentage of PONV was 14.29% at the Suburban hospital location. 60% of the patients in this sample did not receive the appropriate antiemetic prophylaxis, including under and over-administration. Education on patient, anesthetic, and surgical risk factors, and appropriate PONV prophylaxis administration per the Fourth Consensus Guidelines is recommended to improve practice.
Keywords: PONV, gynecologic, ENT, Urologic, surgery, suburban hospital, community hospital, anesthesia