Increasing Utilization of the Apfel Scoring System in High-Risk Patients
- UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
- Tyesha Harvey Neal (Creator)
- Institution
- The University of North Carolina at Greensboro (UNCG )
- Web Site: http://library.uncg.edu/
- Advisor
- Stacey Schlesinger
Abstract: Background: Postoperative nausea and vomiting (PONV) is a side effect following an anesthetic event that impacts 30-80% of patients undergoing general anesthesia (Flood et al., 2021). Patients who are female, have a history of PONV or motion sickness, are non-smokers, and are predicted to require postoperative opioids have increased incidences of PONV. Postoperative nausea and vomiting can lead to aspiration, wound dehiscence, and dehydration. Purpose: This project aimed to reduce the incidence of PONV in female patients undergoing gynecological surgery. Methods: This quality improvement project was completed following the Plan-Do-Study-Act model. An educational intervention on the Apfel scoring system was provided to Certified Registered Nurse Anesthetists (CRNAs). Pre-and post-intervention chart reviews were conducted to compare PONV risk factors, Apfel Scores, prophylactic antiemetic use, and postoperative antiemetic use. A post-intervention survey was used to evaluate CRNA knowledge and confidence. Results: The number of patients who received the appropriate number of prophylactic antiemetics based on their calculated Apfel score decreased from 56% to 50% (z = -0.713, p = .11). The frequency of patients requiring a postoperative antiemetic due to PONV decreased from 37% to 34% (z = -0.746, p = .08). Neither change was statistically significant. Recommendations and Conclusion: In conclusion, there was no statistical change in the number of patients who received the appropriate number of antiemetics based on their calculated Apfel score or the administration of postoperative antiemetics in the PACU. Adoption of the Apfel scoring system will not be recommended to the site. Future projects should explore barriers to clinical application of the Apfel scoring system among CRNAs.
Increasing Utilization of the Apfel Scoring System in High-Risk Patients
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Created on 6/27/2024
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Additional Information
- Publication
- Other
- Language: English
- Date: 2024
- Keywords
- Postoperative nausea and vomiting, Apfel scoring system, PONV gynecological surgery, PONV management