6 0 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
All angles covered
PONV can lead to post-op complications, including pulmonary aspiration, bleed-
ing, wound dehiscence, dehydration, electrolyte imbalance and esophageal rup-
ture, just to name a few. It lengthens patients' stays in recovery and delays dis-
charge. It doesn't do any favors for patient satisfaction, either.
The matching of interventions to patients for effective relief is easier said than
done. Some drugs aren't suitable for some patients, certain patients' comorbidi-
ties contraindicate the use of specific agents, and sometimes providers' knowl-
edge deficits mean that potentially useful doses go untried.
That's the necessity of a multimodal approach, and why the targeted prophy-
laxis specifies minimum numbers of interventions for low-, medium- and high-
risk patients. The higher the risk, the more opportunity you have to potentially
forestall it.
Your providers must ensure, however, that when multiple interventions are
administered, each is selected from different classes of antiemetics. You don't
want to give a patient several doses from the same class of drugs; but instead
aim to work on different receptors for the best chance at PONV prevention.
They must also monitor the incidence of PONV among their patients in PACU
in order to determine whether and which of their interventions worked.
Patient satisfier
Perhaps your pre-op screenings gloss over PONV with a single question: "Have
you experienced problems with anesthesia in the past?" What's more, PONV
incidence rates often go unrecorded and unreported, even though the use of evi-
dence-based tools can help you identify at-risk patients and take preventive
steps against PONV.
Including an evidence-based pre-op screening tool to determine a patient's risk
of PONV in the electronic medical records system can help to streamline aware-
ness, assessment and prophylaxis into the process. It will prompt providers to