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Acupressure in Management of Postoperative Nausea & Vomiting (PONV) in High Risk Ambulatory Surgical Patients
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1.47 6 3.14, T2 3.88 6 3.44, T3 4.63 6 3.5 at all time points. Patients were more likely to receive pain medication if verbal and PABS scores were $ 5 at all time points (T1 77.3%, T2 80.8%, T3 90.2%). PABS and verbal scores correlated at T1 (r50.67, p5.00), T2 (r50.57, p5.00) and T3 (r50.502, p5.00). However, kappa values decreased with time (T1 0.424; T2 0.269; T3 0.193). Statistically significant correlations were found between verbal self-reports and PABS, yet clinically significant variability exists. While both scores were linked to analgesia administrations when scores were $ 5, PABS may not be sensitive enough to guide clinicians’ treatment decisions for pain. As patients emerge from anesthesia the PABS becomes less sensitive as compared to the verbal pain score. Further research is needed to examine pain scoring methods that are sufficiently sensitive and specific for patients unable to self-report.
ACUPRESSURE IN MANAGEMENT OF POSTOPERATIVE NAUSEA & VOMITING (PONV) IN HIGH RISK AMBULATORY SURGICAL PATIENTS Primary Investigator: Debra Hofmann, MS, APNP, ACNS-BC Aspirus Wausau Hospital, Wausau, WI Carrie Murray, MS, RN, ACNS-BC, Janet Beck, BSN, RN
Problem: PONV is a frequent, distressing, costly and potentially preventable traumatic phenomenon in high-risk ambulatory surgical patients that persists despite current pharmacologic prophylaxis and rescue interventions. Acupressure, an energy medicine, has shown promising results in relieving PONV in various surgical populations. There is little research specifically targeting high-risk PONV ambulatory surgical patients. Purpose of the Study: The purpose of this randomized shamcontrolled blinded study was to investigate the efficacy of preoperative placement of acupressure at P6 on PONV incidence in ambulatory surgical patients identified as high risk; measured over 24 hours at three phases of recovery: Phase I (PACU), Phase II (pre-discharge), and Phase III (24 hours post discharge). Methodology: 110 elective ambulatory surgical patients were randomly assigned to receive active acupressure beads/patch (n557) or an inactive placebo acupressure beads/patch (n553) placed unilaterally at P6 Chinese Medicine point 3060 minutes prior to induction of general anesthetic. Nausea and vomiting was assessed using a visual analog scale (VAS) 0-10 during recovery Phase I and II. Participants were contacted by phone for assessment of Phase III PONV within 24-48 hours postoperatively. All participants received usual care including prophylactic and rescue antiemetics and routine instructions for managing nausea and vomiting after discharge. PACU and day surgery nurses assessing nausea and vomiting were blinded to patient group (acupressure or placebo). Results/Discussion: Overall, 110 patients enrolled; 93 patients finished the study’s three phases, 9 were admitted postoperatively and 8 dropped out or data collection on all 3 phases was incomplete. One-way ANOVA and Pearson’s Correlation were used in statistical analyses. Acupressure use at P6
ASPAN NATIONAL CONFERENCE ABSTRACTS preoperatively significantly reduced PONV in all three postoperative phases. Conclusion/Implications for Practice and Future Research: Acupressure is an effective minimal risk, low cost adjunctive therapy for prevention and treatment in ambulatory surgical patients at high risk for PONV. Secondary findings revealed the need for PONV risk factor assessment and evaluation. Further studies using other acupressure points should be conducted.
A COMPARISON OF BEHAVIORAL PAIN SCALES TO THE NUMERIC RATING SCALE IN A POST ANESTHESIA CARE SETTING Primary Investigator: Debra Marshall, RN, BSN, CPAN Rex Healthcare Raleigh, North Carolina Scarlette Evans-Harrop, RN, BSN, Pamela Beacham, RNC MSN, Tonya Gryniv-Chavis, RN, Janet Stevens, RN, Kathie Mulligan, RN, Ramonita Rodrequez-Begley, RN, BSN, Tamara Barnett, RN, MSN, CPAN
Introduction: Patients recovering from anesthesia are not always able to self-report pain. PACU nurses report using patient’s behavior to enhance assessment. In the absence of a standardized approach to behavioral assessment, both the application and interpretation of behavioral cues have been inconsistently applied.: Original research on the PACU Behavioral Pain Rating Scale (PACU-BPRS), the Pain in Advanced Dementia Scale (PAINAD), and the Critical Care Pain Observation Scale (CPOT) have demonstrated reliability and significant correlations with self-report in postoperative patients. Clinical utility and feasibility of the CPOT has been evaluated formally in only a limited number of studies reporting stronger evidence for feasibility than utility. Identification of the Problem: Behavioral pain rating scales are recommended for use in patients unable to self-report. To be valid in practice, these scales must predict self-reported pain levels, respond to changes in pain following analgesia, and be practical to use. In addition, the results must inform clinical decisions. Purpose of the Study: This study compared the PACU BPRS, the PAINAD, and the CPOT to the patient’s perception of pain using the Numeric Rating Scale (NRS) in a mixed surgical population. Methodology: Pearson’s correlation coefficient (r) was used to determine the association between behavioral pain assessment and the NRS score. Multiple regression analyses were used to determine if confounding variables significantly explained differences in pain scores between each of the behavioral pain assessment methods and the NRS pain score. Results: There was a positive and significant relationship between the NRS and all three behavioral pain assessment scales. Correlations were lowest at discharge and highest immediately after analgesic administration. Each behavioral scale consistently underestimated the patient’s self-reporting of pain. Gender was found to be a small but significant contributor to differences between the NRS and the behavioral pain assessment scores with difference scores twice as great for women compared to men at all four time points.
1.47 6 3.14, T2 3.88 6 3.44, T3 4.63 6 3.5 at all time points. Patients were more likely to receive pain medication if verbal and PABS scores were $ 5 at all time points (T1 77.3%, T2 80.8%, T3 90.2%). PABS and verbal scores correlated at T1 (r50.67, p5.00), T2 (r50.57, p5.00) and T3 (r50.502, p5.00). However, kappa values decreased with time (T1 0.424; T2 0.269; T3 0.193). Statistically significant correlations were found between verbal self-reports and PABS, yet clinically significant variability exists. While both scores were linked to analgesia administrations when scores were $ 5, PABS may not be sensitive enough to guide clinicians’ treatment decisions for pain. As patients emerge from anesthesia the PABS becomes less sensitive as compared to the verbal pain score. Further research is needed to examine pain scoring methods that are sufficiently sensitive and specific for patients unable to self-report.
ACUPRESSURE IN MANAGEMENT OF POSTOPERATIVE NAUSEA & VOMITING (PONV) IN HIGH RISK AMBULATORY SURGICAL PATIENTS Primary Investigator: Debra Hofmann, MS, APNP, ACNS-BC Aspirus Wausau Hospital, Wausau, WI Carrie Murray, MS, RN, ACNS-BC, Janet Beck, BSN, RN
Problem: PONV is a frequent, distressing, costly and potentially preventable traumatic phenomenon in high-risk ambulatory surgical patients that persists despite current pharmacologic prophylaxis and rescue interventions. Acupressure, an energy medicine, has shown promising results in relieving PONV in various surgical populations. There is little research specifically targeting high-risk PONV ambulatory surgical patients. Purpose of the Study: The purpose of this randomized shamcontrolled blinded study was to investigate the efficacy of preoperative placement of acupressure at P6 on PONV incidence in ambulatory surgical patients identified as high risk; measured over 24 hours at three phases of recovery: Phase I (PACU), Phase II (pre-discharge), and Phase III (24 hours post discharge). Methodology: 110 elective ambulatory surgical patients were randomly assigned to receive active acupressure beads/patch (n557) or an inactive placebo acupressure beads/patch (n553) placed unilaterally at P6 Chinese Medicine point 3060 minutes prior to induction of general anesthetic. Nausea and vomiting was assessed using a visual analog scale (VAS) 0-10 during recovery Phase I and II. Participants were contacted by phone for assessment of Phase III PONV within 24-48 hours postoperatively. All participants received usual care including prophylactic and rescue antiemetics and routine instructions for managing nausea and vomiting after discharge. PACU and day surgery nurses assessing nausea and vomiting were blinded to patient group (acupressure or placebo). Results/Discussion: Overall, 110 patients enrolled; 93 patients finished the study’s three phases, 9 were admitted postoperatively and 8 dropped out or data collection on all 3 phases was incomplete. One-way ANOVA and Pearson’s Correlation were used in statistical analyses. Acupressure use at P6
ASPAN NATIONAL CONFERENCE ABSTRACTS preoperatively significantly reduced PONV in all three postoperative phases. Conclusion/Implications for Practice and Future Research: Acupressure is an effective minimal risk, low cost adjunctive therapy for prevention and treatment in ambulatory surgical patients at high risk for PONV. Secondary findings revealed the need for PONV risk factor assessment and evaluation. Further studies using other acupressure points should be conducted.
A COMPARISON OF BEHAVIORAL PAIN SCALES TO THE NUMERIC RATING SCALE IN A POST ANESTHESIA CARE SETTING Primary Investigator: Debra Marshall, RN, BSN, CPAN Rex Healthcare Raleigh, North Carolina Scarlette Evans-Harrop, RN, BSN, Pamela Beacham, RNC MSN, Tonya Gryniv-Chavis, RN, Janet Stevens, RN, Kathie Mulligan, RN, Ramonita Rodrequez-Begley, RN, BSN, Tamara Barnett, RN, MSN, CPAN
Introduction: Patients recovering from anesthesia are not always able to self-report pain. PACU nurses report using patient’s behavior to enhance assessment. In the absence of a standardized approach to behavioral assessment, both the application and interpretation of behavioral cues have been inconsistently applied.: Original research on the PACU Behavioral Pain Rating Scale (PACU-BPRS), the Pain in Advanced Dementia Scale (PAINAD), and the Critical Care Pain Observation Scale (CPOT) have demonstrated reliability and significant correlations with self-report in postoperative patients. Clinical utility and feasibility of the CPOT has been evaluated formally in only a limited number of studies reporting stronger evidence for feasibility than utility. Identification of the Problem: Behavioral pain rating scales are recommended for use in patients unable to self-report. To be valid in practice, these scales must predict self-reported pain levels, respond to changes in pain following analgesia, and be practical to use. In addition, the results must inform clinical decisions. Purpose of the Study: This study compared the PACU BPRS, the PAINAD, and the CPOT to the patient’s perception of pain using the Numeric Rating Scale (NRS) in a mixed surgical population. Methodology: Pearson’s correlation coefficient (r) was used to determine the association between behavioral pain assessment and the NRS score. Multiple regression analyses were used to determine if confounding variables significantly explained differences in pain scores between each of the behavioral pain assessment methods and the NRS pain score. Results: There was a positive and significant relationship between the NRS and all three behavioral pain assessment scales. Correlations were lowest at discharge and highest immediately after analgesic administration. Each behavioral scale consistently underestimated the patient’s self-reporting of pain. Gender was found to be a small but significant contributor to differences between the NRS and the behavioral pain assessment scores with difference scores twice as great for women compared to men at all four time points.