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doses of antiemetics at various times throughout the perioperative period. For
example, administering dexamethasone 8 mg IV at induction, ondansetron 4 mg IV
at the end of surgery and oral ondansetron 8 mg post-operatively is more effective
than administering ondansetron 4 mg IV alone at the end of surgery.
Should you administer antiemetics to low-risk patients — those with 1 or no
risk factors? No. Doing so puts them at unnecessary risk of experiencing side
effects related to the therapy and adds unnecessary expense to their treatment.
While the SAMBA guidelines advise against giving antiemetic agents to all
patients, regardless of their baseline risk, they do acknowledge that the addition
of less expensive generics to the market (ondansetron, for example) offers the
possibility of a more widespread use of prophylactic antiemetic therapies.
Solving the problem
CMS has added PONV risk assessment and prevention to the Physician Quality
Reporting System. That means anesthesiologists have to document patients' PONV
risk factors and, if they have 2 or more, administer prophylactic antiemetic agents.
The evolution to pay for performance will be based in part on the appropriate
administration of preventative antiemetic therapy according to the PONV risk
scoring system, so the stakes have been raised in the effort to prevent patients
from feeling sick after surgery.
The incidence of PONV is increasing as outpatient facilities attempt to recover
and mobilize patients faster. Research has shown that PACU staff members rec-
ognized symptoms of PONV only 42% of the time and that only about one-third
of patients at medium to high risk of experiencing PONV were administered
appropriate preventative measures. Those findings suggest that incorporating
multimodal prevention strategies into your facility's anesthesia routines will
help ensure that high-risk patients receive antiemetic interventions. Once that
general approach is established, your anesthesia providers can implementing a
risk-based model.
We need to standardize our efforts to manage PONV. That doesn't mean
