Decreasing the Incidence of Post-Operative Nausea and Vomiting in a Mastectomy/Lumpectomy Patient Population

2.50
Hdl Handle:
http://hdl.handle.net/10755/164622
Category:
Abstract
Type:
Presentation
Title:
Decreasing the Incidence of Post-Operative Nausea and Vomiting in a Mastectomy/Lumpectomy Patient Population
Author(s):
Marchik, Mary
Author Details:
Mary Marchik, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Abstract:
A Breast Surgery/Axillary Dissection Caremap was developed and implemented at University of Iowa hospitals and clinics by a team of surgeons, nurses, pharmacist, and social worker. The goal of the caremap was to standardize care, enhance clinical operations, and improve interventions and outcomes. The team worked diligently to decrease the following variance rates: pain control, wound healing, function of surgical drains, need for home going antibiotic therapy, need for home care referral, prevention of seromas, and to decrease length of stay. The team identified two opportunities for improvement: the presence of postoperative seromas and postoperative nausea and vomiting. Seroma development was discussed. It was determined that practice changes of immobilization of the arm on the operative side, or by increasing the time that surgical drains are left in place were not acceptable. Thus, the seroma formation rate was determined to be beyond the scope of the team. The second issue, nausea and vomiting, was a complication that could be decreased. Retrospectively, 79 charts were reviewed. Frequency of postoperative nausea was collected. Variables evaluated included age, intra-operative anesthetic agents, duration of surgery, postoperative antiemetics, and postoperative narcotics. Seventy five percent exhibited postoperative nausea. This data was presented to the team and the department of anesthesiology as an opportunity for improvement in patient outcomes. The anesthesia physicians indicated that postoperative nausea and vomiting in breast surgery patients has been widely reported in the literature. An anesthesiologist was appointed to the team to assist in development of a plan to help control postoperative nausea and vomiting in the breast surgery/axillary dissection population. The evidence supported two practice changes that anesthesia would trial. First, the use of propofol or propofol-based anesthetics would be recommended. These induction agents are known to have antiemetic properties. Additionally, at the completion of each mastectomy/lumpectomy procedure, intravenous Ondansetron (Zofran) will be given. The practice changes were recommended at Anesthesia Grand Rounds in July 2001. A chart audit will be completed on 80 records six months after implementation to determine whether the recommendations were implemented, to assess for incidence of nausea/vomiting, and if length of hospital stay has decreased.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
27th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleDecreasing the Incidence of Post-Operative Nausea and Vomiting in a Mastectomy/Lumpectomy Patient Populationen_GB
dc.contributor.authorMarchik, Maryen_US
dc.author.detailsMary Marchik, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAen_US
dc.identifier.urihttp://hdl.handle.net/10755/164622-
dc.description.abstractA Breast Surgery/Axillary Dissection Caremap was developed and implemented at University of Iowa hospitals and clinics by a team of surgeons, nurses, pharmacist, and social worker. The goal of the caremap was to standardize care, enhance clinical operations, and improve interventions and outcomes. The team worked diligently to decrease the following variance rates: pain control, wound healing, function of surgical drains, need for home going antibiotic therapy, need for home care referral, prevention of seromas, and to decrease length of stay. The team identified two opportunities for improvement: the presence of postoperative seromas and postoperative nausea and vomiting. Seroma development was discussed. It was determined that practice changes of immobilization of the arm on the operative side, or by increasing the time that surgical drains are left in place were not acceptable. Thus, the seroma formation rate was determined to be beyond the scope of the team. The second issue, nausea and vomiting, was a complication that could be decreased. Retrospectively, 79 charts were reviewed. Frequency of postoperative nausea was collected. Variables evaluated included age, intra-operative anesthetic agents, duration of surgery, postoperative antiemetics, and postoperative narcotics. Seventy five percent exhibited postoperative nausea. This data was presented to the team and the department of anesthesiology as an opportunity for improvement in patient outcomes. The anesthesia physicians indicated that postoperative nausea and vomiting in breast surgery patients has been widely reported in the literature. An anesthesiologist was appointed to the team to assist in development of a plan to help control postoperative nausea and vomiting in the breast surgery/axillary dissection population. The evidence supported two practice changes that anesthesia would trial. First, the use of propofol or propofol-based anesthetics would be recommended. These induction agents are known to have antiemetic properties. Additionally, at the completion of each mastectomy/lumpectomy procedure, intravenous Ondansetron (Zofran) will be given. The practice changes were recommended at Anesthesia Grand Rounds in July 2001. A chart audit will be completed on 80 records six months after implementation to determine whether the recommendations were implemented, to assess for incidence of nausea/vomiting, and if length of hospital stay has decreased.en_GB
dc.date.available2011-10-27T12:04:02Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:04:02Z-
dc.conference.date2002en_US
dc.conference.name27th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationWashington, D.C., USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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