Use of Apfel Simplified Risk Score to Guide Postoperative Nausea and Vomiting Prophylaxis in Adult Patients...

Area of Science:

• Anesthesiology
• Quality Improvement
• Patient Safety

Background:

• Postoperative nausea and vomiting (PONV) is a common adverse event after surgery.
• Effective risk stratification and targeted prophylaxis are crucial for managing PONV.
• Previous methods may not adequately identify all at-risk patients.

Purpose of the Study:

• To implement a quality improvement (QI) project using a standardized screening tool and risk-tailored prophylactic guideline for PONV.
• To identify patients at increased risk for PONV and minimize adverse events.
• To evaluate the impact of the intervention on PONV rates and adherence to guidelines.

Main Methods:

• A pre-post design was used to compare PONV rates before and after intervention.
• The Apfel Simplified Risk Score was implemented for PONV risk screening.
• A combination antiemetic drug class prophylactic guideline was introduced for adult patients undergoing elective same-day surgery.
• Anesthesia professional education and chart review were conducted.

Main Results:

• Forty percent of patients were identified as high-risk (Apfel score 3 or 4).
• PONV rates were similar pre- (19.6%) and post-implementation (22.9%), with no statistically significant difference (P=.5567).
• Anesthesia professional adherence to the prophylactic guideline was high (89.6%).
• A positive correlation was found between higher Apfel scores and PONV onset in the post-group (r_s=0.21, P=.0428).

Conclusions:

• The implemented screening tool and guideline successfully increased the identification of patients at risk for PONV.
• Despite high adherence, the intervention did not significantly reduce the overall PONV rate.
• Further strategies may be needed to effectively decrease PONV incidence in surgical patients.