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A 4 year quality improvement initiative reducing post‐operative nausea and vomiting in children undergoing strabismus surgery at a quaternary paediatric hospital
Author(s) -
Ali Usman,
Tsang Maisie,
Igbeyi Brenda,
Balakrishnan Sindu,
Shackell Kelly,
Kotzer Gloria,
Mc Donnell Conor
Publication year - 2019
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.13664
Subject(s) - nausea , medicine , vomiting , strabismus surgery , strabismus , anesthesia , postoperative nausea and vomiting , incidence (geometry) , population , surgery , physics , environmental health , optics
Background Post‐operative nausea and vomiting is a significant cause of morbidity in pediatric anesthesia. As well as patient discomfort, post‐operative nausea and vomiting can also result in dehydration, delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high risk group for post‐operative nausea and vomiting. Aims The aim of this project was to reduce post‐operative nausea and vomiting by 50% over a period of 12 months. Methods This was a single centre retrospective observational study, with prospective observational follow up. A driver diagram was constructed and smart aim established. The Plan‐Do‐Study‐Act method of quality improvement was used for this project. Benchmark data from one hundred patients was collected retrospectively from patient records. After this, interventions were introduced and serial data was prospectively collected. Statistical process control charts were constructed to monitor percentage bundle compliance and incidence of post‐operative nausea and vomiting in the post anesthetic care unit. Results Post‐operative nausea and vomiting data was collected for 1079 children in total. Baseline incidence of post‐operative nausea and vomiting was 18%. After 4 years this was reduced to 4.72%. At the conclusion of the project there was no significant difference over the previous six months between the incidence of post‐operative nausea and vomiting in the strabismus population and the general post anesthetic care unit population. Conclusion Using quality improvement methodology, we were able to sustainably reduce the incidence of post‐operative nausea and vomiting for children undergoing strabismus repair. We demonstrated using an evidence based therapeutic bundle can reduce incidence of post‐operative nausea and vomiting in the high risk surgical strabismus population to a level comparable to the average post‐operative nausea and vomiting incidence in our post anesthetic care unit population.