SU NSG 470 Reduction of Hospital Adverse Events Discussion

SU NSG 470 Reduction of Hospital Adverse Events Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON SU NSG 470 Reduction of Hospital Adverse Events Discussion Evaluations of the two articles in one page NOT copy and paste please APA 7 edition Please consensus_guidelines_for_the_management_of.13.pdf silence_kills_the_seven_crucial_conversations.pdf Society for Ambulatory Anesthesiology Section Editor: Peter S. A. Glass E SPECIAL ARTICLE CME Consensus Guidelines for the Management of Postoperative Nausea and Vomiting Downloaded from https://journals.lww.com/anesthesia-analgesia by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3JIQl/9XFzqRRCJEERE4fH5IMnNku5+hB7yrfGkeo6WU= on 10/20/2020 Tong J. Gan, MD, MHS, FRCA,* Pierre Diemunsch, MD, PhD,† Ashraf S. Habib, MB, FRCA,* Anthony Kovac, MD,‡ Peter Kranke, MD, PhD, MBA,§ Tricia A. Meyer, PharmD, MS, FASHP,? Mehernoor Watcha, MD,¶ Frances Chung, MBBS,# Shane Angus, AA-C, MS,** Christian C. Apfel, MD, PhD, †† Sergio D. Bergese, MD,‡‡ Keith A. Candiotti, MD,§§ Matthew TV Chan, MB, BS, FANZCA,?? Peter J. Davis, MD,¶¶ Vallire D. Hooper, PhD, RN, CPAN, FAAN,## Sandhya Lagoo-Deenadayalan, MD, PhD,*** Paul Myles, MD,††† Greg Nezat, CRNA, CDR, USN, PhD,§§§ Beverly K. Philip, MD,??? and Martin R. Tramèr, MD, DPhil¶¶¶ The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting. (Anesth Analg 2014;118:85–113) From the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; †Service d’Anesthésiologie–Réanimation Chirurgicale, CHU de Hautepierre, and EA 3072, Faculté de Médecine, Strasbourg, France; ‡Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas; §Department of Anesthesiology, University of Wuerzburg, Wuerzburg, Germany; ?Department of Pharmacy/Anesthesiology, BaylorScott & White Health, Temple, Texas ¶Department of Anesthesiology & Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas; #Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; **Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, Washington, District of Columbia; ††Department of Anesthesia and Perioperative Care, UCSF Medical Center at Mt. Zion, San Francisco, California; ‡‡Department of Anesthesiology, Wexner Medical Center, Ohio State University, Columbus, Ohio; §§Department of Anesthesiology, Perioperative Medicine, and Pain Management, SU NSG 470 Reduction of Hospital Adverse Events Discussion University of Miami, Miami, Florida; ??Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; ¶¶Department of Anesthesia, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ## System Nursing Education and Research, Mission Health System, Asheville, North Carolina; ***Department of Surgery, Duke University Medical Center, Durham, North Carolina; †††Department of Anaesthesia and Perioperative Medicine, Alfred Hospital; Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; §§§Naval Medical Center Portsmouth, Porstmouth, Virginia; ???Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and ¶¶¶Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. Accepted for publication September 13, 2013. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.anesthesia-analgesia.org). Funding: Not funded. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Tong J. Gan, MD, Department of Anesthesiology, Duke University Medical Center, PO Box 3094, Durham, NC 27710. Address e-mail to [email protected] Copyright © 2013 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000002 January 2014 • Volume 118 • Number 1 P ostoperative nausea and vomiting (PONV) are common and distressing to patients. The general incidence of vomiting is about 30%, the incidence of nausea is about 50%, and in a subset of high-risk patients, the PONV rate can be as high as 80%.9–11 Unresolved PONV may result in prolonged postanesthesia care unit (PACU) stay and unanticipated hospital admission that result in a significant increase in overall health care costs.12–14 The goal of PONV prophylaxis is therefore to decrease the incidence of PONV and thus patient-related distress and reduce health care costs.12–15 Several guidelines on the management of PONV have been published.1–7 However, they are either in non-English language,4,5,7 targeted for a specific surgical population,6 or have not been updated in recent years.1–3 A recent update by the American Society of Anesthesiologists task force on postoperative care published practice guidelines for postoperative care.8 Because the scope of the guidelines was broad, covering patient assessment, monitoring, and overall management of patients after anesthesia, and recommendations on the risk assessment and management of PONV were not adequately addressed. The present guidelines are the most recent data on PONV and an update on the 2 previous sets of guidelines published in 2003 and 2007.1,2 A systematic literature search yielded several hundred publications on PONV since the 2007 guidelines, and a number of new antiemetics were introduced along with new data on PONV management strategies. SU NSG 470 Reduction of Hospital Adverse Events Discussion This update includes new information on PONV risk factors including a risk scoring system for postdischarge nausea and vomiting (PDNV); recommendations www.anesthesia-analgesia.org 85 E Special Article WHAT OTHER GUIDELINES ARE AVAILABLE ON THIS TOPIC? Several guidelines on the management of postoperative nausea and vomiting (PONV) have been published.1–7 Among them, 2 were the previous versions of the present guidelines by the same group, published in 2003 and 2007.1,2 One set of guidelines was published by the American Society of Perianesthesia Nurses in 20063 and another published in the Canadian Journal of Obstetrics and Gynaecology in 2008.6 Subsequently, 3 PONV guidelines were published in the French, Spanish, and German language.4,5,7 A recent update on practice guidelines for postoperative care was published by the American Society of Anesthesiologists task force on postoperative care.8 WHY WAS THIS GUIDELINE DEVELOPED? The goal of the current guidelines is to provide current and comprehensive information to practicing physicians, nurse anesthetists, anesthesiologist assistants, pharmacists, perianesthesia, perioperative and ward nurses as well as other health care providers about strategies to prevent and treat PONV in adults and children undergoing surgery. HOW DOES THIS GUIDELINE DIFFER FROM EXISTING GUIDELINES? A systematic literature search yielded several hundred publications on PONV since the 2007 Society for Ambulatory Anesthesia PONV guidelines, and a number of new antiemetics were introduced along with additional new data on PONV risk assessment and management strategies. The present guidelines are the most recent data on PONV and an update on 2 previous sets of guidelines published in 2003 and 2007 by the same group.1,2 The 2 guidelines published in 2006 and 2008 focused primarily on perianesthesia nurses and gynecologists and did not have up-to-date information on the management of PONV.3,6 The other 3 guidelines were published in non-English language.4,5,7 The scope of the postoperative care guidelines published by the American Society of Anesthesiologists were broad, covering patient assessment, monitoring, and overall management of patients after anesthesia, and recommendations on the risk assessment and management of PONV were not adequately addressed.8 WHY DOES THIS GUIDELINE DIFFER FROM EXISTING GUIDELINES? The present guidelines include new information on PONV risk factors; a risk scoring system for postdischarge nausea and vomiting; recommendations on new antiemetics, for example, neurokinin-1 receptor antagonists; changes in recommendations from previous guidelines based on new published information on efficacy and risk of antiemetics, including new data on QT prolongation; recommendation on a new antiemetic combination strategy and a multimodal prevention approach in adults and children to prevent PONV and implementation of PONV prevention and treatment strategies in the clinical setting. on new antiemetics, for example, neurokinin-1 receptor antagonists; changes in recommendations from previous guidelines based on new published information on efficacy and risk of antiemetics, including new data on QT prolongation; recommendation on a new antiemetic combination strategy and a multimodal prevention approach in adults and children to prevent PONV; implementation of PONV prevention and treatment strategies in the clinical setting and a future research agenda for PONV management. SU NSG 470 Reduction of Hospital Adverse Events Discussion The new information is outlined at the beginning of each guideline. The goal of the current guidelines is to provide current and comprehensive information to practicing physicians, nurse anesthetists, anesthesiologist assistants, pharmacists, perianesthesia, perioperative and ward nurses as well as other health care providers about strategies to prevent and treat PONV in adults and children undergoing surgery. ESTABLISHMENT OF EXPERT GUIDELINES The present guidelines were developed under the auspices of the Society for Ambulatory Anesthesia. While the previous 2 sets of guidelines were funded through educational grants, this update received no outside funding. Neither the society nor the experts received any funding from industry for this work. Panel members gathered during a Society for Ambulatory Anesthesia midyear meeting, a day before the commencement of the American Society of Anesthesiologists annual meeting. The primary author convened a multidisciplinary international panel of individuals, some of whom had previously developed the first and second guidelines,1,2 and sought additional experts from other health care disciplines. The panel selections were based on significant expertise in this area of research and representation in professional societies with an interest in 86??? www.anesthesia-analgesia.org the management of PONV. Panel members were asked to review the medical literature on PONV (starting from 2007). Working in groups, the participants researched a specific topic and presented evidence-based data to the group, who discussed the evidence and reached consensus on its inclusion in the guidelines. When full agreement could not be obtained, the majority view was presented, and the lack of full agreement was stated. METHODS We followed the guideline development process similar to that published in 2007.2 A systematic review of the literature concerning PONV management in adult and pediatric patients undergoing surgery was conducted according to the protocol recommended by the Cochrane Collaboration.16 We searched the Cochrane Controlled Trials Register, the Cochrane Library, MEDLINE, and EMBASE from January 2007 to October 2011. A reference librarian and a coauthor (FC) familiar with literature search protocol of the Cochrane Collaboration (Marina Englesakis, Toronto, Ontario, Canada) designed and conducted the electronic search strategy with input from members of the consensus panel. The search was divided into 6 areas: algorithms, prophylaxis, treatment effectiveness, nonpharmacological or alternative therapy, risk assessment, and risk reduction. The Medline search on algorithm of PONV protocols yielded 171 titles, prophylaxis 433 titles, treatment effectiveness 567 titles, and nonpharmacological or alternative therapy 320 titles. The search on risk assessment of PONV yielded 564 titles and risk reduction 549 titles. The search strategy and the keywords used are presented in Appendix 1 (see Supplemental Digital Content 1, http://links.lww.com/AA/A688). We hand-searched the reference lists from the already retrieved anesthesia & analgesia Consensus Guidelines for the Management of PONV articles to identify further trials. The search was limited to human trials but not limited by language. The librarian deleted duplicate records. Clinical studies reported by Fujii et al were excluded due to research misconduct.17 The search results were screened by the authors in a stepwise manner to identify the eligible studies. In the first step, we screened the titles, and irrelevant papers were excluded. In the next step, we read the abstract or full text of the papers for inclusion. SU NSG 470 Reduction of Hospital Adverse Events Discussion The number of and reason for excluded studies in this step were recorded. We selected all reviews, trials, or randomized controlled trials (RCTs) on PONV management (Appendix 1, see Supplemental Digital Content 1, http://links.lww.com/AA/A688). Goals of Guidelines The panel defined the following goals for the guidelines: (1) Understand who is at risk for PONV in adults and postoperative vomiting (POV) in children; (2) Establish factors that reduce the baseline risks for PONV; (3) Determine the most effective antiemetic single drug and combination therapy regimens for PONV/POV prophylaxis, including pharmacologic and nonpharmacologic approaches; (4) Ascertain the optimal approach to treatment of PONV and PDNV with or without PONV prophylaxis; (5) Determine the optimal dosing and timing of antiemetic prophylaxis; (6) Evaluate the cost-effectiveness of various PONV management strategies; (7) Create an algorithm to identify individuals at increased risk for PONV and suggest effective treatment strategies; and (8) Propose a research agenda for future studies. history of motion sickness (1.77, 1.55–2.04), and age (0.88 per decade, 0.84–0.92). The use of volatile anesthetics was the strongest anesthesia-related predictor (1.82, 1.56–2.13), followed by the duration of anesthesia (1.46 h?1, 1.30–1.63), postoperative opioid use (1.47, 1.31–1.65), and nitrous oxide (1.45, 1.06–1.98).19,20 PDNV is a major concern for the anesthesia care provider with the growth in ambulatory surgeries. A new validated simplified risk score for adults for PDNV includes the risk factors of female sex, age <50 years, history of PONV, opioid use in PACU, and nausea in PACU.19 A simplified risk score for PONV in adults is shown in Table 1 and Figure 1. A simplified risk score for PDNV in adults is shown in Figure 2. A simplified risk score for POV in children is shown in Figure 3. Patient Risk Assessment for PONV A number of risk factors have been associated with an increased incidence of PONV. However, some of these factors may be only simple associations. For objective risk assessment, it is recommended to focus on those that independently predict PONV after accounting for other confounding factors. We identified those independent risk Table 1.??Risk Factors for PONV in Adults Evidence Positive overall Scientific Evidence Grading A number of grading systems have been proposed to characterize the strength of evidence of the RCTs and observational studies supporting a treatment. The panel decided to use a scientific evidence grading system previously used by the American Society of Anesthesiologists in their practice guidelines for acute pain management in the perioperative setting (Appendix 2).18 Study findings from published scientific literature were aggregated and are reported in summary form by evidence category, as described below. All literature (e.g., RCTs, observational studies, case reports) relevant to each topic was considered when evaluating the findings. Guideline 1. Identify Patients’ Risk for PONV New information: Additional studies identify the younger age group (<50 years) as a significant risk factor for PONV (odds ratio, OR; 95% confidence interval [CI]): 1.79 (1.39– 2.30) compared with those who are 50 years or older.19 Type of surgery as a risk factor is still debated. New evidence suggests that cholecystectomy: 1.90 (1.36–2.68), gynecological surgery: 1.24 (1.02–1.52), and laparoscopic: 1.37 (1.07–1.77) approach are associated with a higher incidence of PONV when compared with general surgery as a reference group.20 The contribution of intraoperative opioids to PONV is weak, and there is no difference among the different opioids. SU NSG 470 Reduction of Hospital Adverse Events Discussion A recent meta-analysis reaffirmed previously known PONV risk factors but with somewhat different order of importance. Female gender was the strongest patient-specific predictor (OR 2.57, 95% CI, 2.32–2.84), followed by a history of PONV (2.09, 1.90–2.29), nonsmoking status (1.82, 1.68–1.98), January 2014 • Volume 118 • Number 1 Conflicting Disproven or of limited clinical relevance Risk factors Female sex (B1) History of PONV or motion sickness (B1) Nonsmoking (B1) Younger age (B1) General versus regional anesthesia (A1) Use of volatile anesthetics and nitrous oxide (A1) Postoperative opioids (A1) Duration of anesthesia (B1) Type of surgery (cholecystectomy, laparoscopic, gynecological) (B1) ASA physical status (B1) Menstrual cycle (B1) Level of anesthetist’s experience (B1) Muscle relaxant antagonists (A2) BMI (B1) Anxiety (B1) Nasogastric tube (A1) Supplemental oxygen (A1) Perioperative fasting (A2) Migraine (B1) PONV = postoperative nausea and vomiting; BMI = body mass index; MS = motion sickness. Figure 1. Risk score for PONV in adults. Simplified risk score from Apfel et al.9 to predict the patient’s risk for PONV. When 0, 1, 2, 3, and 4 of the risk factors are present, the corresponding risk for PONV is about 10%, 20%, 40%, 60%, and 80%, respectively. PONV = postoperative nausea and vomiting. www.anesthesia-analgesia.org 87 E Special Article Figure 2. Simplified risk score for PDNV in adults. Simplified risk score from Apfel et al.19 to predict the risk for PDNV in adults. When 0, 1, 2, 3, 4, and 5 risk factors are present, the corresponding risk for PDNV is approximately 10%, 20%, 30%, 50%, 60%, and 80%, respectively. PDNV = postdischarge nausea and vomiting; PONV = postoperative nausea and vomiting; PACU = postanesthesia care unit. Figure 3. Simplified risk score for POV in Children. Simplified risk score from Eberhart et al.48 to predict the risk for POV in children. When 0, 1, 2, 3, or 4 of the depicted independent predictors are present, the corresponding risk for PONV is approximately 10%, 10%, 30%, 50%, or 70%, respectively. POV = postoperative vomiting; PONV = postoperative nausea and vomiting. factors that remain significant in multivariable analyses of large cohort studies (Table 1). The most likely causes of PONV are volatile anesthetics, nitrous oxide, and postoperative opioids.21,22 The effect of volatile anesthetics on PONV is dose-dependent and particularly prominent in the first 2 to 6 hours after surgery.21 Irrespective of the specific drug given,23,24 postoperative opioids also increase the risk for PONV in a dose-dependent manner,25 and thi … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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