Transcript Document
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. 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 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 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 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]