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- Title
Preventing Postoperative Nausea and Vomiting During an Ondansetron Shortage.
- Authors
Moore, Chad; Bledsoe, Rusty; Bonds, Raymond; Keller, Margaux; King, Heather
- Abstract
Postoperative nausea and vomiting (PONV) degrades patient experience and increases healthcare costs. Estimates of PONV range from 10% to 80%. The Apfel Simplified Score is an evidence-based instrument for determining individual risk of PONV. Scoring enables anesthesia providers to match antiemetic strategies with the calculated risk of PONV. Data were collected across 3 times. After the Apfel scoring system was automated into the electronic medical record, providers were more likely to increase PONV prophylaxis for patients at highest risk and reduce prophylaxis for patients at lowest risk. Rates of PONV remained similar at baseline (34.7%) and in the early postimplementation period (38.8%); a modest reduction was observed in the final period (26.5%). Intravenous ondansetron, the most common antiemetic at baseline, was not available in the early postimplementation period, which may partially explain the initial increase in PONV. While ondansetron was unavailable, providers began using 3 other antiemetics, a practice that persisted once intravenous ondansetron returned. The Apfel score is an evidence-based tool that providers can use to reduce the risk of PONV. This electronic tool and the reminder cards have been shared across the US Military Health System, fostering an organizational culture that values targeted prophylaxis for PONV.
- Subjects
UNITED States; PREVENTION of surgical complications; INTRAVENOUS anesthesia; INVENTORY shortages; CONFIDENCE intervals; HEALTH care reminder systems; INTRAVENOUS therapy; ACUPUNCTURE; MILITARY medicine; PROMETHAZINE; HETEROCYCLIC compounds; DEXAMETHASONE; ORAL drug administration; SURGERY; PATIENTS; SURGICAL complications; DISEASE incidence; RISK assessment; PREVENTIVE health services; MEDICAL protocols; HUMAN services programs; PRE-tests &; post-tests; NURSE anesthetists; HALOPERIDOL; COMPARATIVE studies; SEX distribution; ONDANSETRON; DRUGS; HOSPITAL nursing staff; CHI-squared test; DESCRIPTIVE statistics; RESEARCH funding; ODDS ratio; DATA analysis software; ANTIEMETICS; ALGORITHMS; POST anesthesia nursing; EDUCATIONAL outcomes; SCOPOLAMINE
- Publication
AANA Journal, 2021, Vol 89, Issue 2, p161
- ISSN
0094-6354
- Publication type
Article