School of Nursing, Duke University, Durham, NC.
School of Nursing, Duke University, Durham, NC.
J Perianesth Nurs. 2022 Aug;37(4):445-451. doi: 10.1016/j.jopan.2021.10.006. Epub 2022 Mar 16.
The quality improvement (QI) project implemented a postoperative nausea and vomiting (PONV) risk screening tool and introduced a risk-tailored prophylactic guideline to identify patients at risk for PONV and aimed to minimize PONV adverse events.
This project represents the initial PDSA (Plan-Do-Study-Act) cycle for quality improvement with use of a pre-post design with two independent groups designed to compare PONV rates before and after implementation of an Apfel Simplified Risk Score screening and prophylactic guideline intervention.
The project implemented the screening of patient PONV risk using the Apfel Simplified Risk Score and a combination antiemetic drug class prophylactic guideline for adult patients undergoing elective same-day surgery procedures. An online education module was provided to anesthesia professionals and was reviewed in-person with the relevant anesthesia professional team prior to surgery. Pre-implementation (N=107) PONV outcomes were collected. Data collected from a retrospective chart review was used to compare pre- and post-implementation PONV rates (N=96) and determine post-implementation anesthesia professional adherence to guideline recommendations.
Forty percent of screened patients were identified as having an increased PONV risk with an Apfel Simplified Risk Score of 3 or 4. The PONV rates for the pre-group (19.6%) and post-group (22.9%) did not significantly differ (P=.5567). Anesthesia professional adherence to administration of the recommended number of antiemetic drug classes was 89.6%. A Spearman point-biserial correlation analysis indicated a significant positive relationship between Apfel Simplified Risk Score and PONV onset in the post-group (r=0.21, P=.0428).
The Apfel Simplified Risk Score and prophylactic guideline increased identification of patients at risk for PONV but did not affect PONV rate despite a high anesthesia professional adherence to the guideline recommendations.
质量改进（QI）项目实施了术后恶心和呕吐（PONV）风险筛查工具，并引入了风险定制的预防指南，以确定有 PONV 风险的患者，并旨在最大限度地减少 PONV 不良事件。
本项目代表了使用预-后设计的初始 PDSA（计划-执行-研究-行动）周期，该设计有两个独立的组，旨在比较实施 Apfel 简化风险评分筛查和预防指南干预前后的 PONV 发生率。
该项目使用 Apfel 简化风险评分对患者 PONV 风险进行筛查，并为接受择期日间手术的成年患者提供一种联合止吐药类预防指南。向麻醉专业人员提供在线教育模块，并在手术前与相关麻醉专业团队进行现场审查。收集实施前（N=107）PONV 结果。使用回顾性图表审查收集的数据比较了实施前后的 PONV 发生率（N=96），并确定了实施后麻醉专业人员对指南建议的遵守情况。
40%的筛查患者的 Apfel 简化风险评分达到 3 或 4，被认为有增加的 PONV 风险。预组（19.6%）和后组（22.9%）的 PONV 发生率无显著差异（P=.5567）。麻醉专业人员对推荐使用的止吐药类别的数量的依从率为 89.6%。Spearman 点二项式相关分析表明，在后组中，Apfel 简化风险评分与 PONV 发作呈显著正相关（r=0.21，P=.0428）。
Apfel 简化风险评分和预防指南增加了对有 PONV 风险的患者的识别，但尽管麻醉专业人员高度遵守指南建议，仍未影响 PONV 发生率。
