Document

Report
Lynn Canale, BSN, RN, CN II
Perioperative Surgical Services
October 22, 2014
Background
Significant
problem & most common
anesthetic complication
 Overall: 30%
High-risk: 80%
Patients fear PONV > Pain

 Patient Satisfaction


Length of Stay


Readmissions


Cost $$$
 Vomiting: ~$305
 $420,900
 Nausea: ~$82
 $113,160
OVER $500,000 per year!
Hill, R.P. et al. (April, 2000). Cost-effectiveness of prophylactic antiemetic therapy with ondansetron,
droperidol, or placebo. Anesthesiology. 92 (4), pp 958-967.


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Where? Mills Surgery Center
Who?
Perioperative nurses
What? Nursing Knowledge: PONV
 Risk Factors
 Prevention
 Management

How? Assessment of nursing knowledge
before and after a class on PONV
What is the impact of an educational program on
perioperative RN’s knowledge of the identification
of risk factors, prevention, and management of
postoperative nausea and vomiting (PONV) in adults
in an outpatient surgical setting?

2000: Jolley
◦ 60% correct

2009: Lewthwaite
◦ 61% correct

2012: Hambridge
◦ Literature review

Identified a gap in nursing knowledge

Inconsistent practice

Need for further education

Identified need for further research
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RNs: very experienced

Questions about our practice:
◦ Is it evidence-based?
◦ Is it based on CURRENT guidelines?

Anesthesiologists: Proactive and thorough

Variable nursing practice

No use of risk assessment tool
2014 Guidelines for Management of PONV

Tested knowledge prior to class (Pre-test)
 Evaluated tool in collaboration with Department of
Anesthesia




30 minute class presented with slides and handouts
Tested knowledge immediately after class (Post-test)
6 nurses/60% of regular staff
Gan, T. J., et al. (January, 2014). Consensus Guidelines for Management of Postoperative Nausea and
Vomiting. Anesthesia & Analgesia. 118 (1), pp 85-111, DOI:10.1213/ANE.000000000000000
PONV:
Percentage of CORRECT answers
100%
80%
60%
40%
69%
88%
20%
0%
Pretest
Posttest

Time limitation

Number of participants

Institutional Review Board




Increase education efforts
Consider HealthStream/new hire
orientation course development
Refine education/test
Collaborate w/anesthesia: update postop
order set

Implement Risk Assessment Tool/Score

Develop article for publication
Future study:
◦ Further data collection
◦ Evaluate additional outcomes◦ LOS, Readmissions, and Patient
satisfaction

PONV remains the main concern of patients

Gaps in nurse’s knowledge around PONV exist


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Nurses: responded favorably, improvement in test
scores
More education for nurses is needed
Ultimate goal of education is to improve outcomes
and experience for surgical patients
No one dies of nausea,
but it can seriously sap the will to live.
Yann Martel

Maria Krajewska-Brown, BSN, RN, CNOR, Clinical Nurse II, Mills Surgery

Sarah Newsom Healy, MSN, RN, CNS, NP-BC, MPA, Cardiovascular APN

Robin Menefee, MSN, RN, Site Director for Surgery Mills Hospital

Vicki White, MSN, RN, VP Acute Care Services/CNO, MPHS

Deborah Martin, Librarian, MPHS

UCSF Center for Nursing Research and Innovation

Jennifer Vickerman, MS, RN, AOCN, CBCN, Oncology CNS, EBP Fellows Site
Coordinator

Diana Hill, RN, CCRC, Clinical Research Manager, PAMF Research Institute

Shahla Bolbolan, MD, Anesthesiologist, MPHS

Betty Irene Moore Foundation

MPHS Private Funder

MPHS 2014 EBP Fellows and Coaches

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Gan, T. J., Meyer, Diemunsch, P., Habib, A. S., Kovac, A., Kranke, P.,
Meyer, T. A., Watcha, M., T., Chung, F., Angus, S., Apfel, C., Bergese,
S., Candiotti, K. A., Chan, M., Davis, P. J., Hooper, V. D., LagooDeenadayalan, S., Myles, P., Nezat, G., Phillip, B. K., & Tramer, M. R.
(January, 2014). Consensus Guidelines for Management of
Postoperative Nausea and Vomiting. Anesthesia & Analgesia. 118 (1),
pp 85-111, DOI:10.1213/ANE.000000000000000
Hambridge, K. (2012). Assessing the risk of post-operative nausea and
vomiting. Nursing Standard. 27,18, pp. 35-43.
Jolley, S. (2000). Postoperative nausea and vomiting: a survey of
nurses’ knowledge. Nursing Standard. 14, 23 pp. 32-34.
Lewthwaite, B. J. (March/April, 2009). What Do Nurses Know About
Post-Operative Nausea and Vomiting? Medsurg Nursing. 18, 2.
Lynn Canale, BSN, RN, CN II
Perioperative Surgical Services
[email protected]

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