Educating Postoperative Nausea and Vomiting Guidelines to Anesthesia Providers - Assignment Example

 Studies have indicated that most surgical patients will experience PONV even if medicines were taken for prevention. PONV is a concern that occurs in 20-30% of patients receiving general anesthesia and can be up to 70-80% in high-risk patients (McCracken, Houston, & Lefebvre, 2008). The Society of Ambulatory Anesthesia (SAMBA), developed a set of guidelines to provide up-to-date information for healthcare providers, including strategies to prevent or treat PONV in patients undergoing surgery (Gan et al., 2007). The purpose of this evidence-based practice (EBP) clinical change project is to introduce various practice guidelines for PONV to anesthesia providers that will enhance their knowledge and, improve customer satisfaction, which is essential for the patient’s health and well-being.

Background

Nausea can often be described as a subjective, unpleasant sensation associated with a conscious urge or need to vomit(Tinsley &Barone, 2012). Vomiting is coordinated by the vomiting center signaling input from various sources including, the higher cortical center in the brain, the vestibular portion, the chemoreceptor trigger zone (CTZ), and the gastrointestinal tract where afferent pathways are stimulated indirectly by specific neurotransmitters (Tinsley &Barone, 2012). Patients experience delays in the post-anesthesia care unit (PACU) for various reasons. According to Chatterjee, Rudra, and Sengupta (2011), vomiting can prolong PACU recovery time by up to 25 minutes.

  During postoperative visits at the project clinical site, patients who have had gynecological and breast procedures have often stated that being nauseated was the most undesirable consequence of surgery, outranking even pain. There are several risk factors involved when evaluating a patient for PONV. These risk factors include patients with a prior history of PONV, motion sickness, non-smokers, females, and the length and type of surgery (Tinsley &Barone, 2012). Mykelejord, Yao, Liang, and Glurich (2012) noted that patients undergoing breast and laparoscopic procedures experience the highest rate of PONV. Additionally, Mykelejord et al. (2012) noted that implementing guidelines resulted in a significant decrease in PONV with laparoscopic gynecological procedures as well as orthopedic and general surgical procedures.

Significance of the Problem

PONV not only results in patient dissatisfaction but also other adverse problems that may impact a patient’s health (Mykelejord et al., 2012). Complications associated with PONV include electrolyte disturbance, pulmonary complications resulting from aspiration, wound dehiscence, and hematomas of the surgical site (Tinsley &Barone, 2012). Studies indicate that PONV delays discharge from the PACU, and increased costs regarding the medication used and nursing staff required (McCracken et al., 2008; Tinsley &Barone, 2012). This causes a burden for the system as well as for the patients.

PICO Question

Evidence-based practice (EBP) implements the best practice, a golden standard for the provision of safe and compassionate health care. Melnyk and Fineout-Overholt (2011) noted that EBP involves a problem-solving approach to clinical practice, integrating a systematic search for and appraisal of the most relevant research to answer a practical clinical question of one’s own clinical experience including patient values and preferences.

A PICO mnemonic is used to identify and work through practical search terms to retrieve the best possible evidence (Melnyk&Fineout-Overholt, 2011). The P stands for patient population or problem of interest. The I stands for intervention. The C represents comparison intervention or status and the O stands for outcome (Melnyk&Fineout-Overholt, 2011). When the components of PICO are combined, a focus question can then be generated. The clinical question that I have formulated is: “When implementing and educating evidence-based guidelines for PONV, will the knowledge obtained by anesthesia providers increase, therefore, decreasing the incidence of nausea and vomiting of patients in the recovery?”

PICO Component Descriptions

 The clinical site identified is located in Central Texas. The anesthesia staff consists of six board Certified Anesthesiologists, 12 full-time Certified Registered Nurse Anesthetists (CRNA), one student nurse anesthetist, and two residents in Anesthesiology. All certified anesthesia providers have practiced for over a year with varied clinical backgrounds and skills. The intervention will include introducing and implementing anesthesia guidelines for the proper use of PONV by all anesthesia providers. Mykelejord et al. (2012) noted when PONV guidelines were utilized, the incidence of nausea and vomiting decreased. This correlation includes comparing the knowledge of providers before implementing PONV guidelines, as well as after proper education. Another factor taken into consideration is comparing the number of patients who experience nausea and vomiting before and after the implementation of guidelines.

The intended outcome identifies an increase in an anesthesia provider’s knowledge and a decrease in nausea and vomiting in patients in the recovery room. Studies have demonstrated that when incorporating these guidelines, providers were able to recognize high-risk patients for PONV and make better drug selections by administering drugs that target multiple pathway trigger zones that are associated with nausea (Mykelejord et al., 2012).

In summary, PONV is still an unmet medical need despite research that has been developed in an attempt to optimize therapy. It is not only unpleasant, causing discomfort to post-op surgical patients, but also affects their normal daily routines that may impede their recovery.