Documentation of Post-operative Nausea and Vomiting in Routine Clinical Practice

Franck, Martin; Radtke, Frank‐Olaf; Apfel, C. C.; Kuhly, Rainer; Baumeyer, Anne; Brandt, Christian; Wernecke, KD; Spies, C.

doi:10.1177/147323001003800330

Cited by 48 publications

(24 citation statements)

References 19 publications

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“…Postoperative patient side‐effects, such as pain, nausea and vomiting, are often not documented in a standardised manner at the ward or put into a comprehensive overall evaluation or overview . Early warning scores, such as the National Early Warning Score (NEWS), have been developed to standardise surveillance of vital functions, but do not include patient's quality parameters.…”

Section: Introductionmentioning

confidence: 99%

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Skraastad

Borchgrevink

Nilsen

et al. 2019

Acta Anaesthesiol Scand

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Background Postoperative pain, side‐effects and time to mobilisation are indicators for the quality of postoperative recovery. The aim of this randomised controlled study was to investigate if efficacy safety score (ESS) combined with a wireless patient monitoring system would improve these clinical outcomes for patients at a general surgical ward. Methods The trial included 195 patients randomised to a standard care group (SC‐Group) or intervention group (INT‐Group) receiving continuous wireless monitoring of vital signs combined with ESS during the first 24 postoperative hours. The primary outcome was time to mobilisation. Secondary outcomes were average pain, doses of postoperative opioids, unscheduled interventions, side‐effects, patient satisfaction and length of hospital stay (LOS). Results Mean time to postoperative mobilisation was 10.1 hours for patients in the INT‐Group compared to 14.2 hours in the SC‐Group; this corresponds to an adjusted hazard ratio of 1.54 (95% confidence interval 1.04‐2.28). INT‐Group patients received a higher dose of oral morphine equivalents; 26 mg vs 15 mg, P < .001; reported lower intensity of pain on a 0‐10 scale; 2.1 vs 3.3, P < .001; and had higher patient satisfaction on a 5‐point scale; 4.9 vs 4.3, P < .001. The LOS was similar between the groups; 71 hours in INT‐Group vs 77 hours in SC‐Group, P = .58. No serious side‐effects were registered in INT‐Group, whereas two were registered in SC‐Group. Conclusions Introducing ESS as a decision tool combined with a wireless monitoring system resulted in less pain, increased satisfaction and more rapid mobilisation for patients in this study. Trial Registration: http://clinicaltrials.gov Identifier: NCT03438578.

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Section: Introductionmentioning

confidence: 99%

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Skraastad

Borchgrevink

Nilsen

et al. 2019

Acta Anaesthesiol Scand

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“…There are widely varying estimates on the incidence of postoperative nausea and vomiting (PONV), a likely result of the diverse set of patients, surgical procedures, and chemicals used, but it is often reported to be approximately 30% (Franck et al, 2010). The incidence of PONV appears to have remained substantially unchanged since as early as the 1950s (see review, Palazzo and Strunin, 1984).…”

Section: Introductionmentioning

confidence: 99%

Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting

Horn¹,

Wallisch²,

Homanics³

et al. 2014

European Journal of Pharmacology

203

130

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Clinical research shows that postoperative nausea and vomiting (PONV) is caused primarily by the use of inhalational anesthesia and opioid analgesics. PONV is also increased by several risk predictors, including a young age, female sex, lack of smoking, and a history of motion sickness. Genetic studies are beginning to shed light on the variability in patient experiences of PONV by assessing polymorphisms of gene targets known to play roles in emesis (serotonin type 3, 5-HT3; opioid; muscarinic; and dopamine type 2, D2, receptors) and the metabolism of antiemetic drugs (e.g., ondansetron). Significant numbers of clinical trials have produced valuable information on pharmacological targets important for controlling PONV (e.g., 5-HT3 and D2), leading to the current multi-modal approach to inhibit multiple sites in this complex neural system. Despite these significant advances, there is still a lack of fundamental knowledge of the mechanisms that drive the hindbrain central pattern generator (emesis) and forebrain pathways (nausea) that produce PONV, particularly the responses to inhalational anesthesia. This gap in knowledge has limited the development of novel effective therapies of PONV. The current review presents the state of knowledge on the biological mechanisms responsible for PONV, summarizing both preclinical and clinical evidence. Finally, potential ways to advance the research of PONV and more recent developments on the study of postdischarge nausea and vomiting (PDNV) are discussed.

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“…Nausea is a symptom that patients find unpleasant and also has an impact on the early physical recovery process (Allvin, Ehnfors, Rawal, & Idvall, ; Mallick‐Searle & Fillman, ; Myles & Wengritzky, ). Regular monitoring for nausea is recommended to enable early treatment (Franck et al., ). This justifies the use of nausea to indirectly monitor the recovery progress.…”

Section: Discussionmentioning

confidence: 99%

“…Current postoperative healthcare routines include regular screening for pain and detection of common adverse events, such as nausea (Gordon et al, 2010). Yet, despite its high prevalence (Lee, Lee, Thinn, Poon, & Liu, 2015) and importance for recovery (Aahlin et al, 2014), only a few patients' who experience nausea are detected by healthcare professionals (Franck et al, 2010). It is only when nausea is detected in real time that healthcare professionals can give correct support to individual patients (Bowyer & Royse, 2016b).…”

Section: Introductionmentioning

confidence: 99%

Nausea intensity as a reflector of early physical recovery after surgery

Eriksson

Årestedt

Broström

et al. 2018

Journal of Advanced Nursing

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Aim To compare different levels of self‐rated average nausea intensity with early physical recovery and determine if nausea can reflect recovery in patients undergoing general or orthopaedic surgery. Background Nausea has been found to influence postoperative physical recovery. Despite the incidence of nausea in postoperative care, there is a knowledge gap about the possibility of using average nausea intensity to reflect recovery, motivating further investigation. Design An observational design with repeated measures. Methods General and orthopaedic patients answered a questionnaire (October 2012–January 2015) about nausea and impact on recovery on postoperative days 1 (N = 479) and 2 (N = 441). Questions about average nausea intensity at rest and during activity were answered based on the Numeric Rating Scale (NRS) (0–10). Impact on recovery was evaluated using three dimensions from the postoperative recovery profile tool. Results About one‐fifth of the patients reported nausea intensity as moderate to severe on days 1 and 2. Nausea intensity was associated with eight of nine aspects of recovery on postoperative day 1. Nausea intensity on day 1 also reflected four of nine aspects of recovery on day 2. About reflecting physical recovery, the association was strongest between nausea intensity and appetite changes. Conclusions As postoperative nausea is common, regular assessments by healthcare professionals are needed. Assessment of nausea is of importance since it reflects physical recovery. This also shows the importance of treating nausea without delay. Using the NRS to measure nausea intensity is a simple method that is easy to use in clinic.

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Documentation of Post-operative Nausea and Vomiting in Routine Clinical Practice

Cited by 48 publications

References 19 publications

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting

Nausea intensity as a reflector of early physical recovery after surgery

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