Rescue Me from PONV: An Evidence-Based Approach

Rescue Me from PONV: An Evidence-Based Approach


Name: Rebecca Baddley

Rank: Ms


Year: 2016


Rescue Me from PONV: An Evidence-Based Approach

Baddley, R., Eccleston, S., and McCarthy, MS., Post Anesthesia Care Unit and Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center, Tacoma, WA

Overview: The moment a patient enters the post anesthesia care unit (PACU) the clinical team must be prepared for anything, including postoperative nausea and vomiting (PONV). 25% of Madigan PACU patients experience PONV for which they receive Zofran and/or Phenergan. Studies reveal Zofran is not a rescue drug but has a role in preventing PONV. The most effective medication in treating PONV is Phenergan. A more patient-centered approach to PONV may also yield benefits for LOS and cost.

EBP Question: In postoperative patients experiencing nausea and vomiting, how does the use of IV Phenergan compared to IV Zofran affect relief of symptoms immediately after medication administration?

Synthesis of Evidence: The Iowa Model of EBP guided our project. PACU orders required nurses to use Zofran as a first line drug to treat PONV. The evidence-based change included removing Zofran and using low-dose (2.5-5mg) Phenergan instead.

Outcomes: Patients report greater satisfaction with PONV management. In a 113-day period, patients (N=603) had an average PACU LOS of 146 (+65) minutes compared to 156 (+73) minutes for patients (N=605) prior to EBP change. Reduced PACU LOS of 10 minutes and change in medication resulted in significant cost savings; $195.35 average per/pt cost savings, and total decrease in cost of $123,887.

Sustainment and Dissemination: Standard order-set change occurred with ongoing education and project presentations for nursing personnel. Dissemination includes presentations to Command staff and PI committees.

Implications for military nursing & future research: MTFs have a high turnover resulting in a perpetual short staffing model; practice changes that decrease LOS and remove barriers to efficiency must be considered. Faster movement translates to PACU bed availability and decreases potential for OR delays. Future research includes post-operative antiemetic use in high risk patients; exploring patient satisfaction information through formal call back surveys.

Word count: 295

Four keywords to classify:
Post-operative Nausea and Vomiting (PONV)
Post Anesthesia Care Unit (PACU)
Length of Stay (LOS)
Evidence-Based Practice (EBP)