In an investigational trial involving 65 patients at Providence St. Patrick Hospital, the need for any additional antiemetics decreased by 71.8% when QueaseEASE was used as a first-line nausea treatment in PACU
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Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications, affecting 20-30% of patients (Abib-Hajbaghery & Hosseini, 2015). Poorly managed PONV can lead to complications beyond the discomfort of nausea and vomiting, including dehydration, electrolyte balance changes, wound dehiscence, and aspiration (Hodge, McCarty, & Pierce, 2014). The standard of practice for treating patients who became nauseated in the St. Patrick Hospital Post-Anesthesia Care Unit (PACU) was to give them a pharmaceutical treatment. These pharmaceutical treatmentsalso pose risks to patients due to some side effects, which include, fatigue, disorientation, dysrhythmias, hypotension, and restlessness (Abib-Hajbaghery & Hosseini, 2015). Another recent complication of antiemetic use is access and availability, due to medication shortages and a patient safety goal of limiting the use of Phenergan. It was this risk awareness that motivated one of the nurses in the St. Patrick Hospital PACU to attend a session on the use of Aromatherapy for PONV in the PACU during the 2018 Magnet Conference. After learning about the ease and potential benefit of this non-pharmacological treatment for PONV, a practice change study was initiated to make aromatherapy a first-line treatment for nausea in the PACU, to reduce the need for pharmacological antiemetics. The project started with a review of the American Society of PeriAnesthesia Nurses (ASPAN) guidelines, and it was found that aromatherapy was included as a nausea intervention option. After establishing aromatherapy as an accepted standard ofcare, a literature review was completed. Eight articles were reviewed, and an evidentiary table was made (see Appendix A). Adata review of antiemetic use for patients in the PACU was also performed to determine how frequently antiemetics were used in the PACU over 6 months (May-November 2018). It was found that of 2,120 patient seen in the PACU, 139 received nausea medication. All patients who complained of nausea received pharmacological treatment.
A literature review was completed to find the effectiveness of aromatherapy on PONV. Eight articles were reviewed and evaluated for strength (see Appendix A). All of the articles reviewed were either randomized controled trials or quasi-experimental studies. All studies reported that no patients experienced increased or worsened nauseaafter treatment, and patient satisfaction was reported as higher with aromatherapy. Anderson & Gross (2004) found that while there was no statistically significant difference in patient nausea rating between those whoreceived either aromatherapy, alcohol, or saline scented gauze, the patientswho received aromatherapy had very high satisfaction scores with an average of 88 on a scale of 100. These results led Anderson & Gross (2004) to recommend aromatherapy as a first-line treatment for nausea. Hunt et al. (2013) also studied different forms of aromatherapy. They had four different groups, ginger only scented gauze, blended scented gauze (ginger, spearmint, peppermint and cardamom), alcohol-scented gauze, and salinegauze (Hunt et al., 2013). The results of their findings showed that blended scents were the most effective in treating nausea, with 82.4% finding relief versus 67.1% who inhaled a single scent (Hunt et al., 2013). Hunt et al. (2013) thus recommended blended scents over single scents. The Brown, Danda & Fahey’s (2018) trial also used a blended aroma product of orange and peppermint scents. They found that after treatment with aromatherapy, 48% of the patients had no nausea, with 70% reporting an improved nausea rating (Brown et al., 2018). These results led Brown et al. (2018) to also recommend blended aromatherapy as a treatment for PONV.
After completing the literature review and finding support for out suggested change of using aromatherapy as a first-line PONV treatment, a practice change study was performed. The process started with getting samples from QueaseEASE, an essential oil-based aromatherapy product that contains peppermint, spearmint, ginger, and lavender. This product was chosen for the following reasons: it was developed by a nurse anesthetist specifically for PONV, it was a blended scent, and was found to be more effective through the literature review. The Soothing Scents company, who distributes QueaseEASE, donated 100 QuickTABS for this study. With the product in hand, the process for its use was developed. This started with the development of a scale for nausea from 0-4, 0 was ‘no nausea’, 1 ‘mild nausea’, 2 ‘moderate nausea with vomiting’, 3 ‘frequent vomiting’, and 4 ‘continuous vomiting’. Once a patient would complain of nausea, the nurse would have them rate their nausea on this scale and then administer the aromatherapy. This was done by removing the foil from the QuickTAB and placing it under the patient’s nose then instructing them to take deep breaths in through their nose and out through their mouths. The aromatherapy would be used for five minutes, then the patient’s nausea would be reassessed. If the nausea had not improved to the patient’s satisfaction, an antiemetic could be offered at that time. The patient’s nausea level would continue to be assessed every 15 minutes until discharge or complete resolution of their nausea. Next, a data collection tool was developed that included risk factors for PONV using the Apfel score. The Apfel score is from 0-4 with a point assigned for every risk factor the patient meets. These factors are female sex, history of motion sickness or PONV, non-smoker, and postoperative opioid treatment. The data collection tool also included patient satisfaction of the treatment they received for their nausea, and if an antiemetic was used. After the development of the data collection sheet and having the product in place the project was presented to the St. Patrick Hospital Institutional Review Board (IRB). Once the IRB approved aromatherapy as an evidence-based practice change study, the aromatherapy project was presented to the surgical services unit-based council for approval. In January of 2019, education was provided to the PACU staff on aromatherapy and how to use the QueaseEASE QuickTAB. An extra data collection sheet was also developed that had additional instruction for staff to assist them in data collecting. The trial began on February 4, 2019. By May, the QuickTAB supply had been used and data collection began.
After compiling all of the datasheets, it was found that either the product was used with no collection sheet filled out or other departments had used some of the QuickTABs. This resulted in there being 65 datasheets after the use of 100 tabs. With the population scored, 28.13% (18 patients) required additional antiemetics. This is a large drop from 100% of patients previously receiving antiemetics for nausea. The study also concluded that 93.75% (60 patients) were satisfied with their treatment. This includes patients for whom the aromatherapy was not effective, 83.9% still found the aromatherapy to be beneficial. From these results, a nurse care guideline was developed for using aromatherapy as a first-line treatment for nausea. Approval for purchasing was also made through St. Patrick Hospital, with plans for QueaseEASE QuickTABs to be stocked inthe PACU.