Paper
Thursday, 20 July 2006
This presentation is part of : Measuring Evidence-Based Practice Outcomes
Adaptation of the OODA Loop to Reduce Postoperative Nausea and Vomiting
Penelope S. Villars, CRNA, MSN, RRT1, Alita A. Campbell-McAdory, RN, OCN2, Joel S. Berger, CRNA, BA, BSN1, Mark Q. Veazie, CRNA, MS, BSN1, and Spencer S. Kee, MD1. (1) Anesthesiology and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA, (2) Post Anethesia Care Unit ACB, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Learning Objective #1: Explain the application of the Observe-Orient-Decision-Act loop to a collaborative nursing practice setting.
Learning Objective #2: Describe an effective strategy to minimize postoperative nausea and vomiting in outpatients.
The Observe, Orient, Decide, and Act (OODA) decision-making framework was adopted as an evidence-based approach to reducing postoperative nausea and vomiting (PONV) in oncologic outpatients who were high risk for PONV.  The OODA loop, developed by Colonel John Boyd USAF, is the premise that the right decision is reached by following of a cycle of observation, orientation, decision, and action. PONV is a high priority for outpatients, thus a strategy that incorporated feedback to alter clinical practice and reduce PONV was implemented.            After baseline PONV data were collected (Observe), a structured PONV prophylaxis plan was based on the available evidence from a literature review.  The knowledge derived from this research and the domain-specific clinical knowledge of a nurse-physician anesthesia team was evaluated in the context of the cancer population and outpatient surgical setting (Orient). These contextualized sources were synthesized into a PONV prevention plan (Decide). The nurse anesthetists were educated on the developed protocol and collaborated with the anesthesiologists in its administration (Action).            The ambulatory surgery center and user-specific PONV rates were posted on a weekly basis. Each incident of PONV was examined to determine possible causes (e.g. failure in preoperative risk assessment, protocol not followed, recommended drugs contraindicated, inadequate fluid administration, etc.). On several occasions, observations from the perioperative and anesthesia nurses (e.g. delayed discharge due to sedation, urinary retention) prompted a new cycle of the OODA loop. Other iterations of the loop included changes in administered drugs, drug doses, and timing of administration. The basic protocol included the preoperative administration of dexamethasone.  This was followed by doses of ondansetron and promethazine thirty minutes prior to emergence from anesthesia. The predicted PONV rate for our population was 23%. The current PONV rate after ten months is less than 6.5%.

See more of Measuring Evidence-Based Practice Outcomes
See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)