Paper: The Implementation of Evidence-Based Practice for the Prevention/Management of Post Operative Nausea and Vomiting (PONV) (19th International Nursing Research Congress Focusing on Evidence-Based Practice)

Wednesday, 9 July 2008

Kathleen DeLeskey, MSN, RN, CPAN , Faculty School of Nursing, Lawrence Memorial / Regis College, Medford, MA

Learning Objective 1: describe how to decrease post operative nausea/vomiting

Learning Objective 2: identify steps to improve the use of evidence based care

Nausea and vomiting is one of the most common post operative complications following the use of inhalation anesthesia. In addition, nausea and vomiting have been identified as causative agents in the delay of discharge and unanticipated admission of ambulatory surgical patients.

Question:

Are we using best practice for the management and treatment of post operative nausea and vomiting (PONV)?

Aims of the project:

~Assess the current use of evidence based care in the treatment of PONV

~Improve the use of evidence in the management of PONV

~improve patient outcomes related to PONV

Based on the evidence, six criteria were developed to ensure the use of best practice in the treatment of PONV. Charts were retrospectively audited to identify where criteria identified by the evidence were not met. Key stakeholders in the treatment of PONV were identified and met to analyze the current situation and develop strategies to address the areas of weakness in the treatment process. Change intervention was then introduced using the Joanna Briggs getting research into practice (GRIP) method. Finally the records were re-audited to assess the effect of the practice change. The project was carried out in a 134 bed community hospital in the northeastern United States. The second audit revealed a significant increase in evidence based treatment for PONV. The overall rate of PONV in the healthcare system also decreased from 18% to 15%. Prior to change management, compliance to EBP criteria was: 2%, 0%, 65%, 31%, 97% and 100% respectively. Following the analysis and strategies to "get research into practice" compliance to audit criteria increased to 63%, 62%, 77%, 49%, 100% and 100% respectively. We have taken further steps to increase our compliance so our treatment of PONV will be fully evidence based.

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