Volume 24 - The Society for the Advancement of Anaesthesia in ...

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SAAD DENTAL NURSE PRIZE WINNER • identification of a particular aspect of practice – in this case PONV in dental patients Table 1 Risk assessment tool (Used in the Department of Oral and Facial Surgery) • assessment of how that practice is carried out, i.e. assessment prior to surgery (Table 1), measuring PONV recovery scores (Table 2) and recording usage of antiemetics CATEGORY SCORE FEMALE 1 NON-SMOKER 1 PREVIOUS PONV 1 MOTION SICKNESS 1 OPIOIDS GIVEN 1 Table 2 Post-recovery score (Used in the Department of Oral and Facial Surgery) ADMISSION TO RECOVERY AFTER 30 MINUTES ON DISCHARGE NO NAUSEA OR VOMITING 0 0 0 MILD NAUSEA, NO VOMITING 1 1 1 MODERATE NAUSEA AND/OR OCCASIONAL VOMITING 2 2 2 SEVERE NAUSEA AND/OR FREQUENT VOMITING 3 3 3 • judgement by peer review as to whether certain standards are being met, i.e. deciding that more than 10% of patients suffering severe nausea is an unacceptable level • identification of areas for improvement • addressing any deficiencies, i.e. education of nurses, introduction of protocols • reassessment after a period of time to check that practice has improved. Audit carried out by the Department of Oral and Facial Surgery in 2005 Total number of patients (day case) 237 Males 77 (32.4%) Females 160 (87.5%) Time of surgery PONV details Exodontic dentistry 182 cases Mean age PONV risk score Total PONV incidence Nausea incidence Vomiting incidence Males 40 (21.9%) 7.54 yrs 2 Females 142 (87.5%) 8.33 yrs 2 20 mins 4.39% 2.7% 1.6% Restorative dentistry 55 cases Mean age Total PONV incidence Nausea incidence 37 21 18 23 1–2 hrs 23.7% 14.6% 9.1% SAAD DIGEST | VOL.24 | JANUARY 2008 15
SAAD DENTAL NURSE PRIZE WINNER Comparison of anaesthetists, exodontia and PONV incidence Anaesthetist PONV 0 PONV 1 PONV 2 PERCENTAGE Dr A Dr R Dr S Dr Z Dr Q Dr B 21 39 3 37 69 6 0 0 1 3 1 0 0 2 0 1 0 0 0 4.8 33 9.7 1.4 0 Comparison of dental surgeons, seniority and PONV incidence Surgeons PONV 0 PONV 1 PONV 2 PERCENTAGE Senior 1 Senior 2 Junior 1 94 44 36 1 1 3 2 0 1 3.19 2.27 11.1 Economics PONV can be very distressing and can have an economic impact. It can prolong the hospital stay and so can have financial implications. The routine use of anti-emetics in all dental anaesthetics must be weighed against the cost of these drugs, which are expensive, and the likelihood of PONV. Protocols in place can address these issues. PONV management There are several factors to consider when managing PONV. • Pre-operative assessment: identify those patients at risk from PONV. • Risk assessment: nurses are in an excellent position to identify patients at risk. A risk assessment tool (Table 1) is used within the author’s department to ensure that all patients are assessed for their probability of PONV. In this risk assessment tool, anyone who scores 3 or above is routinely given anti-emetics for prophylactic reasons. Patients with a lower score than 3 but who have had previous PONV are also given anti-emetics. • Use of prophylactic anti-emetics for those patients considered at high risk of PONV. • Minimising the use of triggering agents during anaesthesia: the use of local anaesthetic reduces the need for opioids in some dental cases. • Accurate charting of nausea and vomiting scores: this helps highlight problems and facilitates audit. The act of recording scores helps focus attention on PONV and, 16 when combined with guidelines for management, will encourage prompt treatment of PONV (1) . In the author’s department all charts are documented in the patients’ anaesthetic notes and reviewed prior to any subsequent anaesthetic (dental or otherwise). • Prompt treatment of PONV: the use of guidelines, along with both doctor/nurse education, facilitates early treatment. Failure to institute treatment early can result in medical complications and patient distress and can influence patients’ expectations of future surgery (1) . • Education programmes: this is one of the areas that is useful regarding nurse education in PONV. A regular programme should be in place to ensure that all staff work together. Research carried out in previous studies has shown that it is an area for improvement, as there were gaps in nurses’ knowledge (8) . • Audit: this assesses working practices and areas for improvement. It works in conjunction with ‘Clinical Governance’ in maintaining standards of care to ensure the best possible care is given to patients (7) . Good patient record-keeping is also important for audit purposes (4) . • Economics: use of guidelines may ensure that valuable resources are targeted at those most at risk (1) . Conclusion It is necessary to monitor how well PONV is being managed to ensure good patient care and prevention of PONV. Patient preparation is important and by carrying out a risk assessment on each patient it ensures that the patients who are classed as ‘high risk’ for PONV SAAD DIGEST | VOL.24 |JANUARY 2008
Page 1 and 2: SAAD DIGEST JOURNAL OF THE SOCIETY
Page 3 and 4: EDITORIAL Welcome to the third volu
Page 5 and 6: REFEREED PAPER techniques was to pr
Page 7 and 8: REFEREED PAPER themes that had surf
Page 9 and 10: REFEREED PAPER not. He’s 11 years
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Page 19 and 20: VISITING PROFESSOR A Sedationist’
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Page 25 and 26: 2007 CONFERENCE SAAD ANNUAL Confere
Page 27 and 28: 2007 CONFERENCE SEDATION IN PRIMARY
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Page 31 and 32: 2007 CONFERENCE 2003: SDAC National
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Page 35 and 36: 2007 CONFERENCE Development of comp
Page 37 and 38: FORUM Frequently and Infrequently A
Page 39 and 40: LETTERS Letter to the Editor Your J
Page 41 and 42: SDAC GUIDELINES Alternative techniq
Page 43 and 44: RESEARCH TOOLKIT Toolkit for Consci
Page 45 and 46: RESEARCH TOOLKIT Quantitative resea
Page 47 and 48: RESEARCH TOOLKIT Wong DL, Baker CM.
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Page 55 and 56: JOURNAL SCAN Dr M. Stille, a physic
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