eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 15
Clinical research

Standardised electronic algorithms for monitoring prophylaxis of postoperative nausea and vomiting

Hans-Jörg Gillmann, Sascha Wasilenko, Jonathan Züger, Antje Petersen, Anna Klemann, Andreas Leffler, Thomas Stueber

Arch Med Sci 2019; 15, 2: 408–415
Online publish date: 2019/03/04
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Despite comprehensive guidelines with high-grade evidence, postoperative nausea and vomiting (PONV) remains a frequent problem in anaesthesia care. Anaesthesia information management systems (AIMS) may aid clinicians in PONV prevention, but their benefit is critically dependent on the details of implementation into practice. This study aimed to examine strengths and weaknesses of the local AIMS-based algorithm in prevention of PONV.

Material and methods
This retrospective study was conducted in the post-anaesthesia care unit (PACU) of a university hospital and included 10 604 patients aged 18 or older who were followed up in the PACU (intracranial, obstetrical or cardiothoracic surgery excluded) from March 2013 until March 2014. The PONV incidence in PACU and AIMS data validity were analysed.

Adherence to PONV guideline recommendations was considerably low, with only 5749 (54%) of the patients receiving correct PONV prophylaxis. Two thousand seven hundred sixty-six (26%) of the patients received an insufficient PONV prophylaxis, which was associated with an excess PONV incidence (11% vs. 4% with correct prophylaxis, p < 0.001) in the PACU. Two thousand four hundred forty-nine (23%) of all patients were discharged from the PACU with an insufficient PONV prophylaxis despite perioperative digital PONV prevention algorithms.

Adherence to PONV prophylaxis guidelines in the era of AIMS software and decision support is still remarkably low. The AIMS data usefulness depends on the user, the type of data input and the configuration of the software. Adherence to correct PONV prophylaxis should be re-evaluated systematically before discharge from PACU.


postoperative nausea and vomiting, patient safety, documentation, anaesthesiology, perioperative management, anaesthesia information management systems

Rusch D, Becke K, Eberhart LH, et al. Postoperative nausea and vomiting (PONV) – recommendations for risk assessment, prophylaxis and therapy – results of an expert panel meeting. AINS 2011; 46: 158-70.
Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014; 118: 85-113.
Piao G, Wu J. Systematic assessment of dexmedetomidine as an anesthetic agent: a meta-analysis of randomized controlled trials. Arch Med Sci 2014; 10: 19-24.
Bembenek JP, Karlinski M, Kurkowska-Jastrzebska I, Czlonkowska A. Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013. Arch Med Sci 2016; 12: 754-9.
Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693-700.
Koivuranta M, Laara E, Snare L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443-9.
Sinuff T, Cook D, Giacomini M, Heyland D, Dodek P. Facilitating clinician adherence to guidelines in the intensive care unit: a multicenter, qualitative study. Crit Care Med 2007; 35: 2083-9.
Kranke P. Effective management of postoperative nausea and vomiting: let us practise what we preach! Eur J Anaesthesiol 2011; 28: 152-4.
Matsota P, Angelidi M, Pandazi A, Tzirogiannis KN, Panoutsopoulos GI, Kostopanagiotou G. Ondansetron-droperidol combination vs. ondansetron or droperidol monotherapy in the prevention of postoperative nausea and vomiting. Arch Med Sci 2015; 11: 362-70.
Avidan A, Weissman C. Record completeness and data concordance in an anesthesia information management system using context-sensitive mandatory data-entry fields. Int J Med Inform 2012; 81: 173-81.
Wanderer JP, Sandberg WS, Ehrenfeld JM. Real-time alerts and reminders using information systems. Anesthesiol Clin 2011; 29: 389-96.
Kooij FO, Klok T, Hollmann MW, Kal JE. Decision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. Anesth Analg 2008; 106: 893-8.
Kooij FO, Klok T, Hollmann MW, Kal JE. Automated reminders increase adherence to guidelines for administration of prophylaxis for postoperative nausea and vomiting. Eur J Anaesthesiol 2010; 27: 187-91.
Kooij FO, Vos N, Siebenga P, Klok T, Hollmann MW, Kal JE. Automated reminders decrease postoperative nausea and vomiting incidence in a general surgical population. Br J Anaesth 2012; 108: 961-5.
el-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82: 1197-204.
Walsh M, Srinathan SK, McAuley DF, et al. The statistical significance of randomized controlled trial results is frequently fragile: a case for a Fragility Index. J Clin Epidemiol 2014; 67: 622-8.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837-45.
Jang J, Yu SH, Kim CB, Moon Y, Kim S. The effects of an electronic medical record on the completeness of documentation in the anesthesia record. Int J Med Inform 2013; 82: 702-7.
Driscoll WD, Columbia MA, Peterfreund RA. An observational study of anesthesia record completeness using an anesthesia information management system. Anesth Analg 2007; 104: 1454-61.
Weiskopf NG, Hripcsak G, Swaminathan S, Weng C. Defining and measuring completeness of electronic health records for secondary use. J Biomed Inform 2013; 46: 830-6.
Gokler ME, Bugrul N, Sarı AO, Metintas S. The validity of self-reported vs. measured body weight and height and the effect of self-perception. Arch Med Sci 2018; 14: 174-81.
Štulc T, Lánská V, Šnejdrlová M, Vrablík M, Prusíková M, Češka R. A comprehensive guidelines-based approach reduces cardiovascular risk in everyday practice: the VARO study. Arch Med Sci 2017; 13: 705-10.
Stueber T, Karsten J, Voigt N, Wilhelmi M. Influence of intraoperative positive end-expiratory pressure level on pulmonary complications in emergency major trauma surgery. Arch Med Sci 2016; 13: 396-403.
Loeb RG. Monitor surveillance and vigilance of anesthesia residents. Anesthesiology 1994; 80: 527-33.
Eberhart LH, Frank S, Lange H, et al. Systematic review on the recurrence of postoperative nausea and vomiting after a first episode in the recovery room – implications for the treatment of PONV and related clinical trials. BMC Anesthesiol 2006; 6: 14.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-2.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe