PWM7: THE EFFECT AND ECONOMIC IMPACT OF STANDARDIZED ORDERS ON THE PREVENTION AND TREATMENT OF PONV IN HOSPITALIZED GYNECOLOGICAL SURGERY PATIENTS

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OBJECTIVES: The risk of post-operative nausea and vomiting (PONV) following gynecological surgery remains high despite effective prophylactic medications. Thus, the objectives of this study were to determine if standardized orders for the prophylaxis and treatment of PONV in gynecological surgery patients: 1) reduce PONV occurrence; 2) reduce total costs; and 3) influence the choice of medications used for PONV prophylaxis and treatment. METHODS: A retrospective design was employed in which a random sample of 200 patients was selected from each of the two 6 month phases before (pre) and after (post) the implementation of standardized orders for PONV prophylaxis and treatment. The primary outcome was the occurrence of any PONV episode. Logistic regression was used to adjust for potential confounding factors. RESULTS: Characteristics were similar except for surgical and anesthesia length between phases. The proportion of patients receiving PONV prophylaxis increased from 31% (pre) to 47% (post, p = 0.002). There was a reduction in the risk of a PONV event in the post phase (OR = 0.67, 95% CI 0.67 to 0.97, p = 0.04). The risk of PONV was significantly reduced with the administration of prophylactic medications (OR = 0.46, 95% CI 0.46 to 0.67). There was a reduction in the mean number of PONV episodes in the post phase (1.81 events) versus the pre phase (1.47 events, p = 0.02). A reduction in mean PONV management costs was observed in the post phase ($8.31, SD 8.50) as compared to the pre-phase ($10.23, SD 8.25, p = 0.02). For mean prophylactic costs, these were significantly higher in the post-implementation phase when compared to the pre-implementation phase ($1.64, SD 3.36 vs. $0.91, SD 2.43, p = 0.013). Univariate sensitivity analyses revealed that the economic results were sensitive to several parameters. CONCLUSION: The implementation of pre-printed order forms for PONV prophylaxis and treatment appears to be an effective and economically attractive strategy.