A CHART AUDIT: USE OF ANTIEMETICS AND NAUSEA AND VOMITING IN THE AMBULATORY POSTOPERATIVE PATIENT

1
A CHART AUDIT USE OF ANTI-EMETICS AND NAUSEA AND
VOMITING IN THE AMBULATORY POST-OPERATIVE
PATIENT Lorilee Amlie, RN, BSN St. Joseph
Hospital, Orange CA Department of Nursing,
California State University, Fullerton

• Results
• Does Ondansetron administration affect length of
  stay (LOS) in the PACU?
• When patients receive Ondansetron intra-op, their
  mean LOS is 30 minutes less than those who did
  not receive Ondansetron intra-op. F(1, 47)3.62,
  p0.06 (see Figure 1)
• Does the timing of Ondansetron affect LOS in the
  PACU?
• When patients received Ondansetron intra-op
  within 30 minutes of the end of their case, their
  LOS in the PACU had a mean difference of 14
  minutes less than those who did not.
• F (1, 42) .69, p .412 (see Figure 2)
• If given a 2nd dose of Ondansetron, how does this
  affect LOS?
• When patients received Ondansetron in both the OR
  and PACU, their mean LOS in PACU was 14 minutes
  longer.
• F (1, 47) .73, p .397 (see Figure 3)
• Patients who receive Ondansetron within 30
  minutes of the end of surgery had a decreased
  chance of experiencing nausea in the PACU (p
  .021). Timing of Ondansetron did not affect
  emesis (p .430).

Introduction Overall incidence of postoperative
nausea ranges from 22-38, and vomiting 12-26
(ASPAN, 2006). Postoperative nausea and vomiting
(PONV) or postoperative vomiting (POV) can
increase pain and time spent in post anesthesia
care units (PACU) and lead to unplanned
hospitalization. PONV occurs up to 70 in high
risk patients (women, patients having abdominal
surgery, history of morning sickness, motion
sickness or PONV). An earlier quality
improvement effort documented that ambulatory
surgery patients are often redosed with the same
antiemetic in the OR and in the PACU.
Ondansetron treatment was found no better than
placebo in rescuing prophylactic failures in
controlling PONV. Eliminating repeat doses of
anti-emetics may reduce length of stay (LOS) for
patients with PONV (Kovac, O'Conner, Pearman,
Kekoler, Edmondson, Baughman, 1999). Purpose
Statement Overall goal -to develop a
comprehensive, clinically useful guideline for
PONV management for outpatient PACU. This chart
audit aims to (a) determine how administration of
ondansetron intra-operatively affects LOS in
PACU, (b) compare single dose with double dose
ondansetron and (c) determine whether timing of
ondansetron affects LOS.
Conclusions Data from this study supports
receipt of Ondansetron within 30 minutes of the
end of a case, decreasing nausea in the PACU.
This intervention may also lead to decreased LOS
in the PACU, a benefit with cost and resource
implications. Implications for
Nursing Re-dosing of unnecessary/ineffective
antiemetic drugs may improve health costs by
saving the cost of the drugs, decreasing LOS, and
decrease hospital admissions. Overall, better
management of PONV would lead to increased
patient satisfaction and symptom
control. Limitations Small sample size from
single hospital incomplete data.

Materials and Methods IRB-approved
retrospective chart review of ambulatory surgical
cases during November 2007. Data was gathered
until 48 specific cases were obtained 16
patients received Ondansetron in OR only 16
patients received Ondansetron in both OR and
PACU 16 patients received Ondansetron in the
PACU only Descriptive data analysis was used to
describe the sample. Chi-squared and one way
ANOVAs were used to determine differences among
groups.
.
References ASPAN. (2006). ASPAN'S
evidence-based clinical practice guideline
for the prevention and/or management of
PONV/PDNV. Journal of PeriAnesthesia Nursing, 21,
230-250. Kovac, A. L., O'Conner, T. A.,
Pearman, M. H., Kekoler, L. J., Edmondson, D.,
Baughman, V. L. et al. (1999, September 11).
Efficacy of repeat intravenous dosing of
ondansetron in controlloing postoperative nausea
and vomiting A randomized, double-blind,
placebo-controlled multicenter trial. Journal of
Clinical Anesthesia, 6, p453-459. Sarti, A.,
Busoni, P., Dell'Oste, C., Bussolini, L.
(2004). Incidence of vomiting in susceptible
children under regional analgesia with two
different anaesthetic techniques. Pediatric
Anesthesia, 14, 251-255.

• Outcomes
• Women and men had similar rates of nausea (women
  66 men 58 ) and vomiting (women 7 men 5
  ).
• Hernia cases had no nausea in the PACU, all other
  cases had nausea.
• Cystoscopy, laparoscopic cholecystectomy, and
  vein ablation cases had vomiting in the PACU.
• Two of four smokers had nausea in the PACU, none
  had emesis.
• History of nausea with surgery, 71 had nausea.
• Past history of emesis in previous surgery, 33
  had emesis.
• History of other N/V, 100 had nausea in the PACU.

Acknowledgments I would like to thank Dr. Dana
Rutledge and Victoria Morrison for their
assistance.