A Nurse-Led Evidence-Based Practice Protocol to Reduce Postoperative Nausea and Vomiting in the Bariatric Surgery Patient

Purpose: To create and implement a standard care bundle to reduce postoperative nausea and vomiting (PONV) in the bariatric surgery patient. Design: Evidence-based quality improvement project. Methods: A pre- and postintervention chart review identified high-risk indicators for PONV in patients with longer lengths of stay (LOS), which led to the development of targeted care bundle components. Findings: A clinically significant difference was observed in predicted PONV for Apfel scores 3 and 4 in patients receiving the full bundle compared with those receiving a partial bundle. Decreased LOS after implementation of the antiemetic care bundle was found. Health care provider compliance with bundle administration was low (57%). Conclusions: Clinically significant PONV scores were low after implementation of the antiemetic bundle for high-risk patients. The nurse-led creation and implementation of an antiemetic care bundle may have contributed to decreased LOS, reduced PONV, and reduced provider variability in care management.