Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting

J Perianesth Nurs. 2019 Aug;34(4):851-860. doi: 10.1016/j.jopan.2018.10.006. Epub 2019 Feb 1.


Purpose: Postoperative nausea and vomiting (PONV) is one of the most common complications after anesthesia. This evidence-based quality improvement (QI) project describes the implementation of a PONV guideline and the impact on providers' compliance with PONV risk assessment using the Apfel PONV score.

Design: A retrospective preimplementation and postimplementation QI project.

Methods: This evidence-based QI project sample included 294 adult female patients scheduled for gynecologic or breast surgery in the ambulatory setting. They were observed for PONV in the postanesthesia care unit. In addition, compliance of Apfel risk-assessment score documentation on the preanesthesia evaluation form was assessed.

Findings: Postimplementation of the guideline, the overall incidence of PONV was significantly lower (9.5% vs 21.1%, P = .009) and anesthesia providers' adherence to Apfel risk score documentation significantly increased (63.3% vs 49%, P = .019).

Conclusions: A PONV guideline for gynecologic and breast surgery can reduce the PONV incidence and improve anesthesia providers' compliance with PONV risk assessment and its documentation.

Keywords: PONV risk screening; female patients and PONV; patient satisfaction; postoperative nausea and vomiting; quality improvement.

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures / methods*
  • Anesthesia / methods*
  • Breast / surgery
  • Female
  • Guideline Adherence
  • Gynecologic Surgical Procedures / methods
  • Humans
  • Incidence
  • Middle Aged
  • Postoperative Nausea and Vomiting / epidemiology
  • Postoperative Nausea and Vomiting / prevention & control*
  • Practice Guidelines as Topic*
  • Quality Improvement
  • Recovery Room
  • Retrospective Studies
  • Risk Assessment / methods