Postdischarge Nausea and Vomiting Risk Assessment in Breast and Gynecologic Surgical Patients.

PURPOSE: Postdischarge nausea, vomiting, and retching often occur after the time of discharge from the postanesthesia care unit (PACU) in patients who have undergone outpatient surgeries. At a large mid-Atlantic Academic Hospital, 40% of gynecologic outpatient surgical patients had postdischarge nausea and vomiting (PDNV). The purpose of this quality improvement project was to implement and evaluate the effectiveness of and staff compliance with the Apfel Postdischarge Nausea and Vomiting Risk Assessment tool to improve PDNV risk screening in the PACU. DESIGN: This quality improvement project was part of an evidence-based practice project. METHODS: After identification and recruitment of key stakeholders and unit champions, a force-field analysis, as part of Lewin's change theory, was completed to identify the driving and restraining forces. All PACU registered nurses received education on the risk assessment protocol using the Apfel risk assessment tool. The Apfel risk assessment tool has been validated to identify five independent risk factors for PDNV in outpatient ambulatory surgical populations. Implementation of the tool with data collection occurred for 8 weeks on all scheduled outpatient breast and gynecologic surgical patients. Staff compliance was measured throughout implementation. FINDINGS: In patients with at least three risk factors present, the Apfel tool correctly identified the risk for PDNV in 68% of patients. In patients with four and five risk factors present, the tool correctly identified the risk for PDNV in 88% and 100% of patients, respectively. Compliance with the tool was high with an average compliance rate of 92% for the 8-week data collection period. CONCLUSIONS: Data analysis demonstrated that the Apfel risk assessment tool adequately predicted the risk for PDNV in outpatient surgical breast and gynecologic patients. Use of Lewin's change theory was successful in maintaining a high compliance rate throughout implementation. In addition, this quality improvement project resulted in increased compliance of the standing follow-up phone call policy. Efforts toward sustainment include expansion to all outpatient surgical populations and implementation of a PDNV prevention and management guideline.

A Retrospective Study: Multimodal Analgesia Quality Measure Implementation and Patient Outcome Assessment.

Current research has demonstrated that nonopioid multimodal analgesia decreases perioperative opioid consumption, postoperative nausea and vomiting (PONV), and pain scores. However, no research has been conducted to examine the patient outcomes of Merit-based Incentive Payment System (MIPS) 477. This study evaluates those outcomes following implementation of MIPS 477. The medical records of 400 adult patients who underwent elective and urgent laparoscopic gynecological procedures at a facility in the Mid-Atlantic region were reviewed. Data collection included patient characteristics, analgesics administered, pain scores at postanesthesia care unit (PACU) arrival and discharge, and antiemetic administration in PACU. This study's primary outcomes were postoperative pain scores, total intraoperative and postoperative opioid consumption, and PONV. Twenty-nine patients (7.8%) met the criteria as a control group, and 341 patients (92.2%) met the criteria as a treatment group. Pain scores were higher upon PACU arrival among the control group (P = .001). The total intraoperative morphine milligram equivalents (MMEs) administered was less among the treatment group (P = .04). The treatment group had reduced total intraoperative MMEs and pain scores at PACU arrival. However, there was no statistical significance in PACU discharge pain score, total PACU MMEs, and PONV in both groups.

Pandemic, Economic Uncertainty, and Protests: What Will Happen to Student Registered Nurse Anesthetists--Resiliency or Burnout?

Nurse anesthesiology education is inherently stressful, and student registered nurse anesthetists (SRNAs) must demonstrate a high level of resilience for successful completion. Because of the coronavirus disease 2019 (COVID-19) pandemic, social unrest from racial protests, and uncertain economic conditions, SRNAs are facing unprecedented levels of stress. Additionally, traditional clinical and didactic training has been drastically interrupted, leading to feelings of anxiety and uneasiness. Much research has demonstrated that high levels of stress and anxiety can lead to burnout and mental health concerns, including fatigue, depression, substance abuse, and suicidal ideation. To prevent burnout, promote resilience, and decrease the risk of severe mental health conditions, nurse anesthesiology educational programs must explore ways to promote students' well-being, through offered wellness interventions and resources.

Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations.

Marijuana consumption is growing in the United States because of state legalization for recreational and medical use. However, many anesthesia practitioners are unaware of the potential adverse effects that may occur if marijuana is taken before the administration of an anesthetic. This review provides a history of marijuana use, the current laws and regulations, the pharmacology of marijuana, and best evidence-based practices related to anesthetic care of the marijuana user.