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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J U N E 2 0 1 8 • O U T PAT I E N TS U R G E R Y. N E T • 5 D espite two centuries of modern medical advancement, nausea remains a distressing and all too common occurrence. Post-operative nausea and vomiting (PONV) is experienced by over half of surgical patients during the recovery process, with up to 37% experiencing it after being discharged (PDNV). While serious complications from vomiting are rare—they include wound bleeding, dehiscence, and aspiration of gastric contents—the frequency at which PONV occurs places a significant strain on hospital resources: it can cause delays in patient discharge, increasing nurse workload, and add avoidable organ-izational costs. It is also one of the most commonly cited causes of patient dissatisfaction after anesthesia. Surveys regularly show PONV as the outcome patients most hope to avoid. According to a 2018 study reported in the Journal of Perianesthesia Nursing, while standard pharmacological treatment "reduces the risk of PONV by 12% to 26%, there is no treatment available that totally eliminates this risk". Of the medications currently available, many face limitations involving either adverse side effects or FDA restrictions, despite their effectiveness: Ondansetron, Promethazine, Droperidol—three common antiemetics used both as prophylactic and rescue agents for surgical procedures—are successful at handling nausea, but can produce moderate to severe side effects including sedation, prolonged QT intervals, low blood pressure, and, in the case of Promethazine, the risk of severe tissue damage if IV infiltration occurs. Additionally, traditional rescue agents face restrictions found in consensus guidelines, like that of the Society for Ambulatory Anesthesia, which recommends that an agent from a different class and targeting a different nausea pathway should be employed if a patient still suffers from PONV after receiving an initial intra-operative prophylaxis. Because patients with the highest risk for PONV will most likely receive 5HT-3 prophylaxis first (such as non-sedating Zofran), it's likely that they will receive a sedating rescue agent, such as Phenergan, and could therefore require additional monitoring. Because this contributes to delayed patient discharge and possible workflow issues, an effective non-sedating rescue agent is a high priority. Because of this, PACU nurses have for decades used isopropyl alcohol (ISA) vapor to reduce PONV. Studies have shown that the inhalation of ISA vapor rapidly interrupts the nausea cycle, effectively relieving PONV by up to 50%. The downside of this method is that patients generally dislike the smell, which discourages patient acceptance and decreases satisfaction with care. This has led to the rise of TIEO therapy (Therapeutic Inhaled Essential Oils, pronounced "tie-oh"), a complementary nausea management practice that involves the inhalation of essential oil vapors to affect the nausea cycle much as ISA does, without the use of drugs or unappealing vapors. Drug-free, natural and pleasant to inhale, TIEO therapy began clinical trials in 2004 with the product QueaseEASE, a blend of four essential oils in specially- designed inhalers created by a nurse anesthetist as a safer and more pleasant alternative to traditional PONV and PDNV management. Currently, TIEO is being used in over 1,500 US healthcare facilities. But what are the advantages of implementing TIEO therapy in lieu of traditional models of care? This paper will answer these questions and outline how current medical policy trends would benefit from adopting TIEO therapy as a nausea management tool. THE RISE OF NONTRADITIONAL PONV MANAGEMENT With the increased emphasis on using evidence-based protocols to ensure enhanced patient recovery at minimal cost, nurses are looking to employ innovative methods that can be administered easily and accessed quickly, to help Therapeutic Inhaled Essential Oil (TIEO) Therapy for PONV Rescue: Why Patients and Healthcare Facilities Need It Now. Sponsored by SPECIAL ADVERTISING SUPPLEMENT