The impact of audit in a district general hospital on post-operative nausea and vomiting after major gynaecological surgery.
An audit of post-operative nausea and vomiting (PONV) was undertaken in 935 female patients who used morphine patient-controlled analgesia (PCA) for pain relief after major gynaecological operations in a district general hospital. We investigated retrospectively five different antiemetic policies and a reference group without policy from January 1993 to July 1995. The department's computerized audit system was used to analyse the observations. At the beginning of the audit, the incidence of nausea and vomiting was as high as 71.5%. But as a consequence of this audit, a departmental policy was adopted 3 years later, which had an incidence of PONV of only 51.7%. During this time the compliance with antiemetic protocols increased from 41% to 76%. There was significantly less PONV if an antiemetic protocol was followed (P = 0.002). This emphasizes the importance of corporate involvement in the development, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significantly irrespective of the type of antiemetic drug used.
Arrowe Park Hospital, Upton, Wirral, UK.
F
F
Hadji
D
D
Eastwood
S
S
Fear
H J
HJ
Corfield
D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000761:Anesthesia Department, Hospital / Q000458:organization & administration*; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002936:Cinnarizine / Q000627:therapeutic use; D002985:Clinical Protocols; D003501:Cyclizine / Q000627:therapeutic use; D004329:Droperidol / Q000627:therapeutic use; D004739:England; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D006767:Hospitals, District / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008485:Medical Audit; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D017294:Ondansetron / Q000627:therapeutic use; D016134:Organizational Policy; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011346:Prochlorperazine / Q000627:therapeutic use; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D000932:Antiemetics; D002936:Cinnarizine; D017294:Ondansetron; D009020:Morphine; D004329:Droperidol; D003501:Cyclizine; D011346:Prochlorperazine