Introduction
Post-operative nausea and vomiting (PONV) causes delayed discharges, unplanned admissions, and an unpleasant patient experience. We assessed whether antiemetic prescribing practices, or rates of PONV had changed in our Day Surgery Unit (DSU) since a 2014 audit.
Methods
Electronic patient records for DSU patients for 5 months were reviewed. We excluded patients receiving inhalational anaesthesia and likely emetogenic procedures. We assessed what and how many antiemetics were given prophylactically in theatre, and rates of PONV. We also distributed questionnaires to anaesthetists and operating department practitioners around antiemetic administration.
Results
60% of patients undergoing a non-emetogenic procedure using total intravenous anaesthesia (TIVA) were pre-emptively given at least one antiemetic. 43% had an Apfel score of 0-1. The overall rate of PONV was 5%. In 2014, our antiemetic prescribing rate was 51% and the overall PONV rate was 5.5%.
Knowledge about emetogenic procedures was high, but even in the lower-risk procedures over 50% said they would administer antiemetics. The highest emesis rate of 18.8% was in those with an Apfel score of 3, who were not given any antiemetics.
Conclusion
Most of our DSU cases receive TIVA and their risk of PONV is low. Prophylactic antiemetic prescription could likely decrease further without increasing PONV rates, avoiding unnecessary drug administration and saving costs. ODP’s have stopped routinely drawing up antiemetics and a reminder of the automatic PONV risk generated on our electronic record has been made. Awareness has been raised about the usefulness of a high Apfel score despite a TIVA technique.
Authors
Jemma Thornes
Torbay and South Devon Foundation Trust, Torquay, United Kingdom
Theresa Hinde
Torbay and South Devon Foundation Trust, Torquay, United Kingdom