Aromatherapy in the PACU: Reducing Postoperative Nausea and Vomiting at UChicago Medicine

To determine if the use of aromatherapy will reduce the incidence of postoperative nausea and vomiting (PONV) in patients recovering in the post-anesthesia care unit (PACU).

DATE: 2018

This evidence-based practice project evaluated whether a personal aromatherapy inhaler (QueaseEASE™) reduces the incidence of postoperative nausea and vomiting (PONV) among patients recovering in the post-anesthesia care unit (PACU).

AUTHORS

Jill De la Vega BSN, RN, CCRN; Cheryl Gilliand BSN, RN; Laura Martinez MSN, RN; Beth Nardi MSN, RN, CAPA, CPAN; Nicole Pierce MSN, RN

SOURCE

Poster presentation, UChicago Medicine PACU (Board 37).

INTRODUCTION

Post-operative nausea and vomiting (PONV) is one of the most common and distressing anesthesia-related complications after surgery.

Of the patients that experience PONV, 30% experience vomiting while 50% experience nausea. High-risk patients may have rates up to 80% (Odom-Forren, 2018).

Patients need alternatives to the pharmacological interventions already provided. Aromatherapy inhalers with ginger, lavender, spearmint, and peppermint are a complementary, non-pharmacological option.

Benefits of aromatherapy include reducing pain, eliminating or managing headaches, providing allergy relief, and anti-emetic properties (Stoicea et al., 2015).

IDENTIFICATION OF THE PROBLEM

PONV can lead to post-surgical complications and cause a delay in patient recovery.

When patients are involved in their care, compliance with medical care increases, mental well-being improves, compliance with post-operative care and patient outcomes improve, and recuperation is promoted.

EBP QUESTION / PURPOSE

The purpose of this study is to determine if the use of aromatherapy will reduce the incidence of PONV in patients post-operatively.

METHODS / EVIDENCE

Patients were asked if they would like to try an aromatherapy inhaler for potential PONV.

The aromatherapy inhaler was then proactively dispensed to patients with onset of any nausea and/or vomiting (N/V) as a first-line intervention.

The PACU nurse completed the questionnaire and placed it in the designated locations. If the aromatherapy inhaler did not offer complete nausea relief, antiemetics were administered as ordered.

FINDINGS / OUTCOMES

96 patients participated in this EBP project.

Pie charts of participant demographics: 74% female and 26% male; 62% no history of PONV and 38% with history; 67% non-smokers, 32% smokers, 1% unsure — Figure 1. Participant demographics: gender, history of PONV, and current smoking status (N = 96).

Mean age of participants: 49.4 ± 14.5 (range 18 to 85).

62 patients (64.6%) received aromatherapy for PONV.

57 patients (91.9%) received the aromatherapy inhaler as a first-line intervention.

The majority of patients who received aromatherapy found it beneficial, with 71% (n=58) reporting either moderate or complete relief from PONV.

Of patients who responded, 90.2% felt QueaseEASE™ was beneficial.

The vast majority reported minor to complete relief, while only 3 had no relief.

Bar chart of patient-reported relief with QueaseEASE: no relief 3, minor relief 14, moderate relief 16, complete relief 25 — Figure 2. Patient report of relief with QueaseEASE™.

Line chart comparing antiemetic rescue-dose rate in PACU, February to July, 2017 vs. 2018 — Figure 3. Anti-emetics administered in PACU, 2017 vs. 2018. Values are approximated from the original poster chart, which did not include point-level data labels.

IMPLICATIONS FOR PERIANESTHESIA NURSES AND FUTURE RESEARCH

Aromatherapy is a branch of herbal medicine in which essential oils are absorbed into the body, resulting in strong physiologic, emotional, and psychologic reactions that are considered beneficial.

Using a non-pharmacologic treatment such as an aromatherapy inhaler reduces the patient’s exposure to possible side effects of IV/IM medications and increases their satisfaction with their post-operative care.

ACKNOWLEDGEMENTS

CCD6 Pre-op/PACU staff nurses, Dr. Glick, Dr. Cutter, Renee Pucik-Maisura, Clinical Director of Perioperative and Procedural Services, and Donna Morrone RN, Care Transition Coordinator.

REFERENCES

Stoicea, N., Gan, T.J., Joseph, N., Uribe, A., Pandya, J., Dalal, R., Bergese, S.D. (2015). Alternative therapies for the prevention of postoperative nausea and vomiting. Frontiers in Medicine, 2, 87. https://doi.org/10.3389/fmed.2015.00087

Apfel, C., Korttila, K., Abdalla, M., Kerger, H., Turan, A., Vedder, I., et al. (2004). A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. New England Journal of Medicine, 350(24), 2441-2451. https://doi.org/10.1056/NEJMoa032196

Mamaril, M., Windle, P., Burkard, J. (2006). Prevention and management of postoperative nausea and vomiting: a look at complementary techniques. Journal of PeriAnesthesia Nursing, 21(6), 404-410. https://doi.org/10.1016/j.jopan.2006.09.007