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.