Implementation of the Apfel Simplified Risk Score (ASRS): A Quality Improvement Project

Background: Postoperative nausea and vomiting (PONV) is one of the most common adverse effects in a patient undergoing general anesthesia. A failure to provide a risk assessment for PONV can lead to negative post-surgical experiences, decreased patient satisfaction scores, and complications. Local Problem: Some hospital systems do not use an evidence-based risk assessment tool to identify patients at risk for PONV. Methods: A quality improvement project using the Apfel Simplified Risk Assessment Score (ASRAS) tool was implemented to identify and educate pre-operative patients at a high risk for PONV. Data were collected using an anonymous open-ended questionnaire pre-and post-intervention, an analytics report for rates of reported nausea and vomiting, and compliance rates with the ASRAS tool. A Chi-squared analysis was completed with significances at p < 0.05. Intervention: Following education and a pre-intervention survey, ASRAS was implemented on adult patients receiving general anesthesia by the pre-operative nurse during the pre-operative interview over an 8-week period. Results: Nurse’s compliance with the ASRAS tool fluctuated with an average compliance rate of 71%. Rates of nausea increased by 3.4% and vomiting decreased by 0.9%. This is clinically but not statistically significant. Staff’s perception of the need for the tool, comfort performing the tool, and perception of how well the facility educates on PONV was statistically significant.
Conclusion: Nurse’s compliance with the ASRAS tool increased by the end of the project despite multiple barriers identified. Nausea rates increased while vomiting decreased.

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Work Title Implementation of the Apfel Simplified Risk Score (ASRS): A Quality Improvement Project
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Penn State
Creators
  1. Nina Clay
  2. Brandi Peachey
  3. Susan Leight
  4. Sheilah Yohn
Keyword
  1. DNP Project
  2. Apfel
  3. PONV
License In Copyright (Rights Reserved)
Work Type Project
Publication Date February 2024
Subject
  1. PONV
  2. Risk Assessment Score
Deposited May 16, 2023

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Version 1
published

  • Created
  • Updated
  • Added Creator Nina Clay
  • Updated Description, Publication Date Show Changes
    Description
    • Background: Postoperative nausea and vomiting (PONV) is a significant problem and one of the most common adverse effects in a patient undergoing general anesthesia. A failure to provide a risk assessment for the postoperative nausea and vomiting surgical patients can lead to negative post-surgical experiences, decreased patient satisfaction scores, and complications.
    • Local Problem: Some hospital systems do not use an evidence-based risk assessment tool to identify patients at risk for PONV. Identifying patients at high risk for PONV is recommended by The American Society of Enhanced Recovery and Society of Ambulatory Anesthesia as well as the Society of Ambulatory Anesthesia.
    • Methods: A Risk assessment tool will be implemented to aide in identification and education of the high risk PONV pre-operative patients. Pre-and post-intervention qualitative data will be collected using an anonymous open-ended questionnaire. Pre-and post-intervention quantitative data will be collected using a Likert-based survey, an EPIC analytics report for rates of PONV and compliance measurement of the ASRAS, and explaining of results to the patient. A chi-squared analysis will be done using a p<0.05 as significant
    • Intervention: Following education and a pre-intervention survey, the Apfel Simplified Risk Assessment Score (ASRAS) will be implemented by the pre-operative nurse during the pre-operative interview over an eight-week period. The nurse will educate the patient on their risk based on the computed score. Compliance rates of using the tool and providing education will be assessed weekly. The survey and EPIC analytics report results will be analyzed at the conclusion of the study.
    • Background: Postoperative nausea and vomiting (PONV) is one of the most common adverse effects in a patient undergoing general anesthesia. A failure to provide a risk assessment for PONV can lead to negative post-surgical experiences, decreased patient satisfaction scores, and complications.
    • Local Problem: Some hospital systems do not use an evidence-based risk assessment tool to identify patients at risk for PONV.
    • Methods: A quality improvement project using the Apfel Simplified Risk Assessment Score (ASRAS) tool was implemented to identify and educate pre-operative patients at a high risk for PONV. Data were collected using an anonymous open-ended questionnaire pre-and post-intervention, an analytics report for rates of reported nausea and vomiting, and compliance rates with the ASRAS tool. A Chi-squared analysis was completed with significances at p < 0.05.
    • Intervention: Following education and a pre-intervention survey, ASRAS was implemented on adult patients receiving general anesthesia by the pre-operative nurse during the pre-operative interview over an 8-week period.
    • Results: Nurse’s compliance with the ASRAS tool fluctuated with an average compliance rate of 71%. Rates of nausea increased by 3.4% and vomiting decreased by 0.9%. This is clinically but not statistically significant. Staff’s perception of the need for the tool, comfort performing the tool, and perception of how well the facility educates on PONV was statistically significant.
    • Conclusion: Nurse’s compliance with the ASRAS tool increased by the end of the project despite multiple barriers identified. Nausea rates increased while vomiting decreased.
    Publication Date
    • February 2024
  • Updated Acknowledgments Show Changes
    Acknowledgments
    • Brandi Peachey, DNP, FNP-BC, CNE, Susan B. Leight, EdD, CRNP, FNP-C, ANP-BC, FAANP, FAAN, Sheilah Yohn DNP FNP-BC
  • Updated Subject Show Changes
    Subject
    • PONV, Risk Assessment Score
  • Added Clay_NG_Implementation of the Apfel Simplied Risk Score- A Quality Improvement Process.docx
  • Updated Work Title Show Changes
    Work Title
    • Implementation of the Apfel Simplified Risk Assessment Score (ASRAS): A Quality Improvement Project
    • Implementation of the Apfel Simplified Risk Score (ASRS): A Quality Improvement Project
  • Updated Acknowledgments Show Changes
    Acknowledgments
    • Brandi Peachey, DNP, FNP-BC, CNE, Susan B. Leight, EdD, CRNP, FNP-C, ANP-BC, FAANP, FAAN, Sheilah Yohn DNP FNP-BC
  • Added Creator Brandi Peachey
  • Added Creator Susan Leight
  • Added Creator Sheilah Yohn
  • Added Clay_N_Implementation of the Apfel Simplied Risk Score- A Quality Improvement Process.docx
  • Deleted Clay_NG_Implementation of the Apfel Simplied Risk Score- A Quality Improvement Process.docx
  • Updated License Show Changes
    License
    • https://rightsstatements.org/page/NoC-US/1.0/
  • Updated License Show Changes
    License
    • https://rightsstatements.org/page/NoC-US/1.0/
    • https://rightsstatements.org/page/InC/1.0/
  • Updated License, Publication Date Show Changes
    License
    • https://rightsstatements.org/page/InC/1.0/
    • https://rightsstatements.org/page/NoC-US/1.0/
    Publication Date
    • February 2024
    • 2024-02
  • Updated License Show Changes
    License
    • https://rightsstatements.org/page/NoC-US/1.0/
    • https://rightsstatements.org/page/InC/1.0/
  • Published
  • Updated