Nursing - Reducing postprocedure emesis
Putting research into practice
PATIENTS UNDERGOING procedures at my facility’s cardiac electrophysiology (EP) lab typically receive I.V. procedural sedation with fentanyl (Sublimaze) and midazolam (Versed), which keep them sedated and comfortable throughout lengthy procedures. Unfortunately, in some patients these drugs also cause vomiting, which is particularly dangerous for a sedated patient. In addition, vomiting may trigger bleeding at vascular access sites.
Nurses in the EP lab and those receiving patients postprocedure believed that, despite the use of the antiemetic promethazine (Phenergan), too many patients were still suffering from nausea and vomiting. So the nursing staff decided to collect data on these occurrences in a performance improvement project on I.V. procedural sedation safety and effectiveness.
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Prospective data collection began in the first quarter of 2002 (January to March). A nurse in the EP lab started a data form on each of the patients surveyed. The form was completed by an RN in the unit who cared for the patient in the first 24 hours postprocedure. Results from the first quarter showed that 21% of EP patients surveyed (12 of 57) had episodes of nausea or vomiting that required nursing intervention within 24 hours after the procedure.
When the EP nurses shared this information with the physicians, the physicians agreed that nausea and vomiting was a significant problem. To improve patient safety and comfort, they agreed to order ondansetron (Zofran). Highly effective for controlling postprocedure nausea and vomiting, ondansetron is associated with fewer adverse reactions than phenothiazines and antihistamines.
Data collected in the following quarter (April to June 2002) demonstrated dramatic results: Of 46 patients surveyed, only 1 experienced nausea and vomiting requiring intervention. Data collected in the next quarter showed continued improvement in postprocedure nausea and vomiting, with just 7 of 54 patients (13%) experiencing some nausea. Some patients receiving large doses of I.V. procedural sedation or undergoing lengthy procedures also received promethazine if nausea or vomiting persisted despite ondansetron.
Nurses continue to collect data to establish the reliability of these results. Data collected on 247 patients reveal that only 22 experienced nausea; 91% of patients were nausea-free. This change in practice has improved patient safety and comfort, and decreased nursing time needed to care for patients postprocedure.
BY MARGE WARESAK, RN, BSN
Marge Waresak is a clinical nurse IV in the electrophysiology lab and the chair of the Performance Improvement Committee at Duke University Hospital, in Durham, N.C. Doing It Better is coordinated by Myra F. Ellis, RN, CCRN, CS, MSN, clinical nurse IV, cardiothoracic ICU, Duke University Hospital.
Copyright Springhouse Corporation Jun 2004
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