A Clinical Decision Tool to Guide Prevention of Adult Postoperative Nausea and Vomiting during Ondansetron Shortages

Abstract

Nausea and vomiting frequently complicate recovery from anesthesia. Postoperative nausea and vomiting (PONV) are concerning to patients, with some patients fearing PONV more than postoperative pain. PONV remains a significant problem in anesthesia because of the multitude of consequences such as unexpected hospital admission, delayed recovery, and return to work of ambulatory patients, pulmonary aspiration, wound dehiscence, and dehydration. The antiemetic drug, ondansetron, is recognized as the standard of care in the prevention and treatment of PONV, but this medication is frequently on the national drug shortage list. The primary purpose of this Doctor of Nursing Practice (DNP) project was to develop an evidence-based clinical practice tool to guide PONV prevention practices during ondansetron shortages, to be used by anesthesia providers at a hospital in the Tucson area. The objectives for this project included exploring facility practices surrounding PONV prevention during ondansetron shortages, educating anesthesia providers on available alternative antiemetics during shortages, and evaluating the perceived usefulness of a clinical decision tool on PONV prevention practices. Lewin’s Change Theory and The Johns Hopkins Evidence-Based Practice (EBP) Model were utilized as the quality improvement, conceptual frameworks to facilitate translation of current evidence into best practices. Expert practitioners (N=7) were educated on the clinical decision tool modeled after the 2014 Society of Ambulatory Anesthesia (SAMBA) consensus guidelines. 100% of participants agreed or strongly agreed that the proposed clinical decision tool would enhance PONV prevention practices during ondansetron shortages. Project results were reported to the facility’s Director of Professional Practice and the anesthesia department’s chief Certified Registered Nurse Anesthetist (CRNA).