A 4 year quality improvement initiative reducing post-operative nausea and vomiting in children undergoing strabismus surgery at a quaternary paediatric hospital
| Autor: | Kelly Shackell, Usman Ali, Gloria Kotzer, Sindu Balakrishnan, Conor Mc Donnell, Maisie Tsang, Brenda Igbeyi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent Nausea Population 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology 030225 pediatrics medicine Humans Prospective Studies Strabismus education Child Retrospective Studies education.field_of_study business.industry Incidence (epidemiology) Retrospective cohort study Hospitals Pediatric Quality Improvement Anesthesiology and Pain Medicine Child Preschool Pediatrics Perinatology and Child Health Postoperative Nausea and Vomiting Vomiting Observational study Female medicine.symptom business Strabismus surgery |
| Zdroj: | Paediatric anaesthesia. 29(7) |
| ISSN: | 1460-9592 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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