Evaluation of the Implementation of ASPAN's Evidence-Based Clinical Practice Guideline for the Prevention and/or Treatment of Postoperative Nausea and Vomiting

Stephens, Lisa

Evaluation of the Implementation of the ASPAN’s Evidence-Based Clinical Practice Guideline for the Prevention and/or Treatment of Postoperative Nausea and Vomiting

Lisa Stephens DNP, CRNA

Assistant Professor Georgia Regents University

Augusta, GA

Aims: Postoperative nausea and vomiting (PONV) impacts up to 60% of surgical patients annually. Evidence based guidelines have been developed to guide the prevention/management of PONV; however the impact of guideline implementation on patient outcome has not been evaluated. The purpose of this study was to evaluate the relationship of implementation of anesthesia specific guideline recommendations to the incidence of PONV. A cost/benefit analysis was also conducted.

Methods: A secondary data analysis was conducted of local data (N=94) obtained during a prospective multi-center trial involving medical record abstraction and patient journaling (N = 2170). The purpose of the original study was to develop a simplified risk model for the prediction of PDNV.

Results: Data analysis included descriptive statistics and correlation. 38% of patients were treated according to guideline recommendations; 37% were undertreated and 19% over-treated. Overall incidence of PONV was 22.3%. Number of PONV risk factors and number of anti-emetic medications administered were weakly correlated (r = 0.21, p = 0.004). Incidence of PONV was 18.4% for patients treated according to guideline recommendations, and 35.1% in undertreated patients. Incidence of PONV was 5.2 % in patients that were over-treated.

Conclusion: Risk assessment through the use of evidence-based guidelines such as the ASPAN Guideline helps identify patients who would benefit from prophylactic antiemetics and assist providers in identifying strategies to greatly reduce or even eliminate its occurrence. Future research determining the efficacy of the ASPAN guideline is necessary to suggest changes, if any, to the guideline and guide future advancements in algorithm development to eliminate PONV.