October 2019 -In a trial conducted by Kaiser Permanente Fontana Medical Center results revealed 67% of patients did not require additional antiemetics after administering QueaseEASE in the PACU setting and 100% of the trial participants stated they found QueaseEASE to be beneficial.
Read more: Kaiser Permanente Fontana Medical Centre – PACU Department Postoperative Nausea and Vomiting Aromatherapy TrialTEAM LEADERS
Sarah Todd, BSN, RN
Lisa Haas, BSN, RN
DATA ANALYSIS
Dean McCann, Data Consultant, Perioperative Services
BACKGROUND
Quality improvement projects have shown that aromatherapy can be used as an adjunct modality to decrease self-reported nausea and discharge delays (Brown, Danda, & Fahey, 2018).
Postoperative Nausea (PON) is one of the most undesirable outcomes after surgery, thus increasing patient dissatisfaction, increasing risk of recovery complications and increasing cost.
SETTING
A no-cost trial of QueaseEASE was held in the main PACU from October 7th to November 8th, 2019.
PARTICIPANTS
QueaseEASE QuickTAB was available for PACU nurses to use any time they felt it would be beneficial to the patient. During this time period, 58 patients used QueaseEASE and we received a data collection form from the patients. Of the respondents, 79.3% were female, 51.7% had a history of PONV and/or motion sickness, 10.3% had a history of smoking and 32.8% had a history of anxiety
RESULTS
Of the 58 patients who used QueaseEASE, 67% of them did not require additional antiemetics. During this trial, 100 percent of the patients stated that they felt QueaseEASE was beneficial even if it had no effect on nausea. Subjective data from the data collection forms related to relief of postoperative nausea and vomiting were that 72.4% said it completely resolved their nausea; 15.5% said it was helpful, but still had some nausea; 10.3% said it gave them minor relief but still felt nauseated and 1.7% said it had no effect on nausea.
QueaseEASE accomplished what was hoped it would do as evidenced by every patient who used it, felt that it was beneficial. Two-thirds of patients who used QueaseEASE needed no additional antiemetics and even if the patient did require additional antiemetics, they still felt that QueaseEASE was beneficial and 87.9% of patients who used it felt it reduced their nausea.
DISCUSSION
Safety/Cost: By using QueaseEASE, we will decrease our use of other antiemetics. Ondansetron costs between $0.50 and $0.60/vial and has side effects of increasing the QT interval, stomach pain, dizziness, drowsiness, and the risk of serotonin syndrome (Lexicomp, 2019). Another antiemetic used frequently in the PACU that we can reduce or eliminate the use of with QueaseEASE is Metoclopramide. One dose of metoclopramide is $1.00-2.00 (per Clarissa D. Lopez, Pharm.D.). Metoclopramide has a black box warning with cumulative use of tardive dyskinesia and has the side effects of drowsiness, fatigue, and restlessness (Lexicomp, 2019).
Reduced Length of Stay: Our trial demonstrated a reduction in PACU I and II time. The 32 outpatients who used QueaseEASE showed a 22% reduction in PACU II length of stay and of the 20 inpatients, 46% of the inpatients had a lesser PACU I time.
Patient Experience of Care: The clinical benefit to improving experience of care is demonstrated by overwhelming patient satisfaction with 100% of patients stating QueaseEASE was beneficial. The QuickTAB is effective for 72 hours which provides the patient continued self-management of queasiness throughout the PACU, Phase II and post discharge timeframe to alleviate discomfort from hospital to home.
Patient satisfaction scores will be monitored to see if there were any changes during the month of the trial.
CONCLUSION
The QueaseEASE product is a safe and effective non-pharmacological method to reduce postoperative nausea and vomiting. With 100% patient satisfaction and almost 90% reduction of nausea and/or vomiting, there is enough value for our patients to bring this product on permanently. It is all natural and drug free. It does not need a doctor’s order and is for use by anyone, regardless of age or medical condition. The Quick Tab is designed for patient safety and is fully recyclable and BPA free. This product is used at other Kaiser facilities and over 1,000 other hospitals and clinics.
STATEMENT OF SUCCESSFUL PRACTICE
The QueaseEASE product is a safe and effective non-pharmacological method to reduce postoperative nausea and vomiting. With 100% patient satisfaction and almost 90% reduction of nausea and/or vomiting, there is enough value for our patients to bring this product on permanently. It is all natural and drug free. It does not need a doctor’s order and is for use by anyone, regardless of age or medical condition. The Quick Tab is designed for patient safety and is fully recyclable and BPA free.
REFERENCES
Brown, L., Danda, L., & Fahey, I. T. J. (2018). A quality improvement project to determine the effect of aromatherapy on postoperative nausea and vomiting in a short-stay surgical population. AORN Journal, 108(4), 361-369. https://doi.org/10.1002/aorn.12366
Lexicomp (2019). Metoclopramide [Commercial and CA Marketplace: Formulary-G] [Med Part D: Tiered] (Kaiser Southern California Formulary). Retrieved from https://online-lexi- com.kaiserpermanente.idm.oclc.org/lco/action/doc/retrieve/docid/kaifoc_f/57171#adr
Lexicomp (2019). Ondansetron Hydrochloride [Commercial and CA Marketplace: Formulary] [Med Part D: Tiered] (Kaiser Southern California Formulary). Retrieved from https://online-lexi- com.kaiserpermanente.idm.oclc.org/lco/action/doc/retrieve/docid/kaifoc_f/57242