Outpatient Surgery Magazine

Manager's Guide to Surgery's Ambulatory Anesthesia - July 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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5 8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5 Measure and intervene Studies have shown that if a surgical patient population goes untreated, about 30% of the patients will suffer PONV. Without prophylaxis, a patient's risk of experienc- ing the complication is as follows (in rounded figures): • no risk factors: 10% • 3 risk factors: 60% • 1 risk factor: 20% • 4 risk factors: 80% • 2 risk factors: 40% Intervention is clearly an important aspect of PONV prevention, and increasing- ly so for patients who present with multiple risk factors. When our anesthesia team set out to improve our PONV prevention protocols, we first attempted to find out how frequently PONV occurred at the hospital where we provide anes- thesia services, with an eye on tracking the trend over time. We were surprised to find that the data we were seeking didn't exist. In fact, there hadn't even been Out in the forefront of PONV prevention literature is the Society for Ambulatory Anesthesia's "Consensus Guidelines for the Management of Postoperative Nausea and Vomiting," published in the January 2014 issue of the journal Anesthesia & Analgesia (osmag.net/pDa6AG). These guidelines, an updated version of SAMBA's 2003 and 2007 recommendations, advise providers to adopt the Apfel simplified risk scoring system to judge adult patients' likelihood of suffering PONV. That means you should score patients during a pre-op assessment using the following PONV risk factors: • female patients, 1 point; • non-smokers, 1 point; • patients who will receive post-op opioids, 1 point; and • patients with a history of PONV or motion sickness, 1 point; Totaling the factors gives you a PONV risk score of zero to 4 points. These risk scores are then stratified as follows: • 0 or 1 point: low risk. • 2 points: moderate risk. • 3 or 4 points: high risk. PONV POLICY Who's Most at Risk? z DATA CRUNCHERS Cristina Brooks, BSN, RN, CPAN (left), Andrea Moppin, RN, CCRN (seated) and Chris Smith, CRNA, DNP, review patients' pre-op assessments.

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