Outpatient Surgery Magazine

Marking Madness - April 2013 - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 143 of 157

OSM560-April_DIGITAL_Layout 1 4/5/13 2:33 PM Page 144 ANESTHESIA ALERT ing system for patients undergoing anesthesia. Patients get 1 point for each of the following risk factors: female, history of PONV or motion sickness, non-smoker and post-operative use of opioids. Risk increases as the total points increase: An individual with no risk factors has a 10% chance of experiencing PONV, whereas a female non-smoker who is likely to receive narcotics for pain control after surgery (3 risk factors) has a 60% chance of experiencing PONV. Our study's results reinforced the fact that men are not immune to PONV, yet we often forget about the male patient with a history of motion sickness. By applying the Apfel scoring system to all patients, men and women alike are now identified if they're at increased risk. To better communicate this risk to the entire team, the PONV history was added to our anesthesia questionnaire and to our SBAR (situation, background, assessment, recommendation) tool used in relation to all patient communication. 2 Attack the problem After screening and communicating the risk and recommendations to the anesthesia provider, we use best practices that were determined from the literature to prevent and combat PONV. • Fluids. Research suggests dehydration is a precursor to PONV. Surgical patients are NPO, and that puts them at increased risk. For example, a 150-lb. patient who has been NPO for 10 hours is 1 liter behind on fluids. Recognizing this fact, we now start our IVs and 1 4 4 | O U T PAT I E N T S U R G E R Y M A G A Z I N E | A P R I L 2 013

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