Evaluation of a Screening Tool to Prevent Post-Operative Nausea and Vomiting

Abstract

Purpose. Does educating, performing, and documenting a pre-operative/post-operative nausea and vomiting assessment increase knowledge and likelihood of administering the recommended amount of prophylactic antiemetics by anesthesia providers at St. Mary’s Hospital? Background. Although post-operative nausea and vomiting triggers, patient risk factors, and prophylactic treatment strategies are widely studied, rates remain as high as 30% in surgical patients. Current evidence suggests patients at risk for post-operative nausea and vomiting have more significant prophylactic benefits if they are identified before surgery. Moreover, using multimodal preventive therapy for patients deemed at moderate or high-risk has been shown to decrease institution-wide prevalence. Methods. Participants were Certified Registered Nurse Anesthetists (CRNAs) at a local Tucson, Arizona hospital. Two interventions were utilized during this exercise. First, an evidence-based pre-operative/post-operative nausea and vomiting assessment tool (Apfel Assessment) was added to documentation. Participants were then sent an email containing an educational video with instructions outlining the use and location of the Apfel Assessment as well as changes to the updated 2020 Clinical Practice Guideline prevention strategies. After viewing the video, participants were asked to rate their knowledge level and willingness to participate in both assessing patients preoperatively using the Apfel Assessment and using recommended prophylactic interventions. Results. Survey results found participants who viewed the educational video unanimously rated themselves as highly knowledgeable in their ability to perform an Apfel Assessment, how to correlate Apfel Score to risk level, recommended number of antiemetics to administer based on Apfel Scores and guidelines, and their ability to list six different antiemetics available for use in the hospital’s formulary. When compared to participant low to moderate knowledge levels reported prior to viewing the project’s educational content, results yielded a standard deviation of 0.00. Additionally, 75% of participants stated they would always implement recommended antiemetic strategies after watching the educational video. Conclusions. Key findings were statistically, and clinically significant and support the use of an educational video to enhance anesthesia provider knowledge and willingness to participate in evidenced based post-operative nausea and vomiting reduction strategies.