Thomas John Stephenson, Maple Ingrid K, Norcross William, Muckler Virginia C
J Perianesth Nurs. 2019 Feb;34(1):74-85. doi: 10.1016/j.jopan.2018.02.007. Epub 2018 Jun 23.
This article describes the implementation of a postoperative nausea and vomiting (PONV) risk prediction and prophylaxis protocol.
This is a retrospective pre/post implementation quality improvement project.
This project used chart reviews to assess the impact of the implemented PONV assessment and prophylaxis in a sample population of adult females undergoing gynecologic surgical procedures.
The mean number of prophylactic antiemetics administered significantly increased during the postimplementation period from 3.64 (SD, 0.878) in the preimplementation period to 4.07 (SD, 1.021) in the postimplementation period (P < .001). The greatest increase in antiemetic administration occurred in the moderate-risk (risk score, 4) and the high-risk (risk score, 5 to 6) groups. The incidence of PONV decreased from 32.3% in the preimplementation period to 28.9% in the postimplementation period; however, this reduction did not meet statistical significance. Antiemetic administration compliance increased from 37% in the preimplementation group to 61% in the postimplementation group (P < .001).
The results of this project suggest that a risk-tailored approach to PONV prophylaxis using a risk assessment tool along with treatment recommendations is effective at reducing the incidence of PONV. The effectiveness of this approach is limited by the involvement of the anesthesia providers responsible for completing the assessments and administering PONV prophylaxis.
本文描述了术后恶心呕吐（PONV）风险预测与预防方案的实施情况。
这是一项实施前/后回顾性质量改进项目。
本项目通过病历审查，评估已实施的PONV评估与预防措施对接受妇科手术的成年女性样本群体的影响。
实施后阶段预防性使用止吐药的平均数量显著增加，从实施前阶段的3.64（标准差，0.878）增至实施后阶段的4.07（标准差，1.021）（P <.001）。止吐药使用增加最多的是中度风险（风险评分4）和高风险（风险评分5至6）组。PONV的发生率从实施前阶段的32.3%降至实施后阶段的28.9%；然而，这一降低未达到统计学显著性。止吐药使用的依从性从实施前组的37%增至实施后组的61%（P <.001）。
本项目结果表明，使用风险评估工具及治疗建议对PONV预防采取风险针对性方法可有效降低PONV的发生率。这种方法的有效性受到负责完成评估和实施PONV预防的麻醉医护人员参与情况的限制。
