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]