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PONV Risk Assessment with Apfel Score

This document outlines a quality improvement project at a hospital to reduce post-operative nausea and vomiting (PONV) by giving at least two anti-emetics to eligible high-risk patients. It lists various anti-emetic medications that could be used preoperatively and postoperatively, including the dose, mechanism of action, side effects, cautions, and acquisition cost for each medication. The goal is to assess patients' Apfel score and give combination anti-emetic therapy to those with a score of 3 or 4 to effectively prevent PONV.

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Julie
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55 views1 page

PONV Risk Assessment with Apfel Score

This document outlines a quality improvement project at a hospital to reduce post-operative nausea and vomiting (PONV) by giving at least two anti-emetics to eligible high-risk patients. It lists various anti-emetic medications that could be used preoperatively and postoperatively, including the dose, mechanism of action, side effects, cautions, and acquisition cost for each medication. The goal is to assess patients' Apfel score and give combination anti-emetic therapy to those with a score of 3 or 4 to effectively prevent PONV.

Uploaded by

Julie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Resident

QI Project 2016-17

Goal: Give ≥ 2 anti-emetics


to every eligible patient
PONV RISK ASSESSMENT
with Apfel score 3 or 4
PONV RISK ASSESSMENT
Anti-Emetics Dose Mechanism Major Side Effects Use with Caution for Patients with: Acquisition Cost

PreOp
Scopolamine 1 patch Muscarinic antagonist Anticholinergic, CNS depression Frail patients, Age >65yo $16.54/patch
Aprepitant 40mg PO Substance P/NK1 receptor antagonist None Hepatic insufficiency $83.09/40mg tab
After Induction
Dexamethasone 4mg IV Centrally acting anti-inflammatory Infection risk, Hyperglycemia, GI bleed Diabetes, Sepsis, Bone fusion cases $0.16/20mg vial
Diphenhydramine 25-50mg IV Histamine antagonist CNS depression Frail patients, Age >65yo $0.55/50mg vial
Hydroxyzine 25mg IM Histamine antagonist QT prolongation, CNS depression Frail patients, Age >65yo $3.01/25mg vial
Ephedrine 25mg IM Mechanism unknown None MAO-I/TCA/SNRI use $11.45/50mg vial
Prior to end of surgery
Ondansetron 4 mg IV 5-HT3 antagonist QT prolongation, Serotonin syndrome Hepatic insufficiency $1.21/4mg vial
Parkinson, Antipsychotic use, Frail patients, Age
Prochlorperazine 5-10 mg IV D1+D2 antagonist, Histamine antagonist Anticholinergic, Extrapyramidal, CNS depression >65yo $10.79/10mg vial
Impaired GI motility, Pheo, Seizure disorder,
Metoclopramide 20 mg IV Dopamine antagonist QT prolongation, CNS depression, Extrapyramidal Antipsychotic use $0.77/10mg vial
Haloperidol 1 mg IV/IM Dopamine antagonist Extrapyramidal, CNS depression Parkinson, Antipsychotic use $5.55/5mg vial

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