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CLINICAL AUDIT: LOW COMPLIANCE WITH THE DEPARTMENTAL ALGORITHM FOR PROPHYLAXIS RESULTS IN A N INCREASED INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING. A RETROSPECTIVE OBSERVATIONAL STUDY
ESRA Academy. Staelens W. Sep 8, 2016; 138259
Topic: Safety of Regional Anaesthesia - Complications - General Aspects
Walter Staelens
Walter Staelens

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Abstract
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Background and Aims:

Postoperative nausea and vomiting (PONV) remains one of the most important complications experienced by patients after general anesthesia. Clinical practical guidelines have been established to prevent and manage PONV. Unfortunately, limited knowledge of and low adherence to guidelines is a well-known problem in the management of PONV. The objective of this study was to audit the implementation of departmental PONV guidelines and its impact on the incidence of PONV in our institution.

Methods:

We reviewed the medical records of all consecutive adult patients undergoing elective non-cardiac, non-day-case surgery under general anesthesia and being admitted to our post-anesthesia care unit during an arbitrarily chosen week. In particular, we noted the incidence of nausea, vomiting and PONV after 1 and 24 hours, whether and how PONV prophylaxis and treatment were administered, and the compliance with the departmental algorithm for PONV prophylaxis.

Results:

Preoperatively, the PONV risk was correctly calculated only in 36%. Only 22% of the patients received correct PONV prophylaxis. The overall-incidence of PONV after 24 hours was 33%.  Among all patients with an Apfel risk score of >2 and experiencing PONV, we found a significantly higher incidence of incorrect vs. correct prophylaxis (95% vs. 5%, p<0.0001, and 96% vs. 4%, p<0.0001, respectively). 

Conclusions:

To overcome significant shortcomings in the knowledge and implementation of the departmental algorithm and the correct assessment of the PONV risk, we propose a simplified approach in which the number of prophylactically administered anti-emetics is determined by gender. 

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