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Including Aromatherapy for Management of Postoperative Nausea and Vomiting, an Evidence-Based Practice Project
ASPAN NATIONAL CONFERENCE ABSTRACTS Process of Implementation: Staff in Recovery Rooms have been noted to place isoprophyl (IPA) swabs on the nose of patients suffering from PONV. Literature searches for alternative treatments to PONV also identified IPA as a safe, cost effective, and an easily accessed treatment. These studies led the team to measure and analyze the effects of this treatment on patients at MUSC. Staff were informed of the project and given instructions on the process via email. Team members were available to staff for questions. Data collection sheets were used to measure the severity of PONV after standard treatment (antiemetic administration) and IPA treatment. Protocol for administration of IPA was to place an opened IPA swab under the nose of the PONV patient and have them inhale 3 times. If nausea were not relieved, standard treatment would commence along with repeating IPA swab inhalation 2 more times for a total of 3 sequences. Statement of Successful Practice: The results of the study showed 40% of the IPA group were without nausea 5 minutes and 10 minutes after initial treatment. Fifteen minutes after initial IPA treatment, 60% were without nausea and 30 minutes after treatment, 40% of the IPA group were nausea free. These results show an improvement in PONV with the addition of IPA to standard treatment in comparison to standard treatment alone. Implications for Advancing the Practice of Perianesthesia Nursing: The Team agreed that this project continue to obtain a larger sample size. The benefits of adding IPA inhalation to standard treatment of PONV can be included in PACU orientation manuals to improve the severity of PONV in post-operative patients.
INCLUDING AROMATHERAPY FOR MANAGEMENT OF POSTOPERATIVE NAUSEA AND VOMITING, AN EVIDENCE-BASED PRACTICE PROJECT Team Leader: Jennifer Amedio, BSN RN CPAN CAPA CCRN PCCN Houston Methodist Willowbrook Hospital, Houston, Texas
Background Information: Post-Operative Nausea and Vomiting (PONV) has a high occurrence in our Post Anesthesia Care Unit (PACU) which contributes to PACU delays in average of 29.6%. Research shows that one third of all surgical patients will experience PONV. We selected the Aromatherapy project to provide a more comprehensive multimodal approach for better management of PONV that could reduce PACU delays. Objectives of Project: To include aromatherapy Quease Ease (QE) for the management of PONV to the current medication regimen in PACU and reduce PACU delays. Process of Implementation: The project was reviewed by the Internal Review Board (IRB) and was determined to be an Evidence-Based Practice (EBP) project. The project involved adding the use of aromatherapy QE for treatment of PONV to the current antiemetic medication regimen. The following four measurements were obtained. First Measurement Patients who experienced PONV were asked to rate their nausea on a Verbal Descriptive Scale (VDS) from 0-10. The first VDS rating was obtained upon onset of PONV and the second at 3-5 minutes following the aromatherapy. Note: All abstracts are printed as received from the authors.
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Second measurement The percentage of those patients who did not require further treatment after receiving the aromatherapy was compared to those who did. Third measurement A total of Promethazine and Ondansetron use for 3 months pretreatment was compared to 3 months post-treatment. Fourth measurement The amount of recovery time spent in the PACU during the pretreatment months was compared to the post-treatment months. Statement of Successful Practice: Including the aromatherapy for PONV showed very significant results in all four measurements: 1. A reduced average nausea VDS rating of 2.82 after treatment with QE 2. A reduction of 37% of patients that did not require further antiemetic treatment after receiving the aromatherapy 3. A reduction of 43 Promethazine doses and 34 Ondansetron doses during the post- treatment months 4. A reduction of 6 minutes recovery time spent in PACU during the post-treatment months Implications for Advancing the Practice of Perianesthesia Nursing: Adding aromatherapy to the current medication regimen provides a comprehensive multimodal approach for better management of PONV and reduces PACU delays as evidenced by the four measurements.
STAY JUST A LITTLE BIT LONGER: EXTENDED RECOVERY IN THE PACU Team Leader: Krista Hall, RN BSN CPAN University of Colorado Hospital, Aurora, Colorado Team Members: Kristen Alix, RN MS ACNP-BC CVN, Nicole Babu, RN BSN CPAN, Michelle Ballou, RN MSN MBA CPAN, Monica Brock, RN MSN, Omid Jazaeri, MD FACS, Justin Oeth, RN BSN, Amanda Swedhin, RN BSN CMSRN
Background Information: Endovascular Aneurysm Repair (EVAR) for Abdominal Aortic Aneurysms and Carotid Endarterectomy (CEA) procedures historically warranted an ICU admission. Evidence supports that ICU monitoring for uncomplicated, elective procedures is not always necessary and misallocates costly ICU admissions. Patients undergoing these procedures who meet specific criteria can be safely transferred to the progressive care unit (PCU) after a six-hour extended stay in the Post Anesthesia Care Unit (PACU). Objectives of Project: Create an evidence-based PACU Extended Stay program for patients post EVAR or CEA surgeries who meet inclusion criteria in order to facilitate safe transfer to the PCU postoperatively. Process of Implementation: Evidence-based guidelines and order sets were developed to use when caring for extended stay patients in the PACU. This involved multidisciplinary collaboration with vascular surgery, nursing, and pharmacy. Education opportunities on caring for this patient population were provided for both PACU and PCU nurses.
INCLUDING AROMATHERAPY FOR MANAGEMENT OF POSTOPERATIVE NAUSEA AND VOMITING, AN EVIDENCE-BASED PRACTICE PROJECT Team Leader: Jennifer Amedio, BSN RN CPAN CAPA CCRN PCCN Houston Methodist Willowbrook Hospital, Houston, Texas
Background Information: Post-Operative Nausea and Vomiting (PONV) has a high occurrence in our Post Anesthesia Care Unit (PACU) which contributes to PACU delays in average of 29.6%. Research shows that one third of all surgical patients will experience PONV. We selected the Aromatherapy project to provide a more comprehensive multimodal approach for better management of PONV that could reduce PACU delays. Objectives of Project: To include aromatherapy Quease Ease (QE) for the management of PONV to the current medication regimen in PACU and reduce PACU delays. Process of Implementation: The project was reviewed by the Internal Review Board (IRB) and was determined to be an Evidence-Based Practice (EBP) project. The project involved adding the use of aromatherapy QE for treatment of PONV to the current antiemetic medication regimen. The following four measurements were obtained. First Measurement Patients who experienced PONV were asked to rate their nausea on a Verbal Descriptive Scale (VDS) from 0-10. The first VDS rating was obtained upon onset of PONV and the second at 3-5 minutes following the aromatherapy. Note: All abstracts are printed as received from the authors.
e19
Second measurement The percentage of those patients who did not require further treatment after receiving the aromatherapy was compared to those who did. Third measurement A total of Promethazine and Ondansetron use for 3 months pretreatment was compared to 3 months post-treatment. Fourth measurement The amount of recovery time spent in the PACU during the pretreatment months was compared to the post-treatment months. Statement of Successful Practice: Including the aromatherapy for PONV showed very significant results in all four measurements: 1. A reduced average nausea VDS rating of 2.82 after treatment with QE 2. A reduction of 37% of patients that did not require further antiemetic treatment after receiving the aromatherapy 3. A reduction of 43 Promethazine doses and 34 Ondansetron doses during the post- treatment months 4. A reduction of 6 minutes recovery time spent in PACU during the post-treatment months Implications for Advancing the Practice of Perianesthesia Nursing: Adding aromatherapy to the current medication regimen provides a comprehensive multimodal approach for better management of PONV and reduces PACU delays as evidenced by the four measurements.
STAY JUST A LITTLE BIT LONGER: EXTENDED RECOVERY IN THE PACU Team Leader: Krista Hall, RN BSN CPAN University of Colorado Hospital, Aurora, Colorado Team Members: Kristen Alix, RN MS ACNP-BC CVN, Nicole Babu, RN BSN CPAN, Michelle Ballou, RN MSN MBA CPAN, Monica Brock, RN MSN, Omid Jazaeri, MD FACS, Justin Oeth, RN BSN, Amanda Swedhin, RN BSN CMSRN
Background Information: Endovascular Aneurysm Repair (EVAR) for Abdominal Aortic Aneurysms and Carotid Endarterectomy (CEA) procedures historically warranted an ICU admission. Evidence supports that ICU monitoring for uncomplicated, elective procedures is not always necessary and misallocates costly ICU admissions. Patients undergoing these procedures who meet specific criteria can be safely transferred to the progressive care unit (PCU) after a six-hour extended stay in the Post Anesthesia Care Unit (PACU). Objectives of Project: Create an evidence-based PACU Extended Stay program for patients post EVAR or CEA surgeries who meet inclusion criteria in order to facilitate safe transfer to the PCU postoperatively. Process of Implementation: Evidence-based guidelines and order sets were developed to use when caring for extended stay patients in the PACU. This involved multidisciplinary collaboration with vascular surgery, nursing, and pharmacy. Education opportunities on caring for this patient population were provided for both PACU and PCU nurses.