All-Natural PONV Prevention

Essential oils are a growing adjunct therapy used to bolster the effectiveness of traditional antiemetics for PONV. A disposable tab containing a combination of lavender, ginger, peppermint and spearmint oils can be clipped to the gowns of patients to prevent the complication they all dread.

Even when the effects of PONV are relatively minor on the range of potential post-op issues, feeling nauseous is a significant patient satisfaction issue. PONV can be the main thing patients remember from the surgical experience, even if the clinical outcome was a good one. Nothing can ruin an otherwise stellar score on a satisfaction survey than a patient getting sick in a recovery bay.

It’s not entirely clear why essential oils reduce PONV in many patients. The thought is the scents trigger physiological responses that relax muscles of the gastrointestinal system. Patients like aromatherapy because they control the administration and actively participate in their recoveries. Nurses like it because it’s a quick remedy that doesn’t require a physician’s order to use.

“One of the reasons using aromatherapy as an adjunct is so fantastic is in the reduced anxiety it facilitates,” says Gerianne Fraddosio, MSN, RN, CNOR, director of ambulatory surgery at BayCare Health System in St. Petersburg, Fla. “It improves the impact of the medications that are on board.” 

BayCare includes aromatherapy in its routine care plan, a factor that helps sell patients on its use — although a hard sales pitch is rarely needed. “We tell patients the oils are in addition to the medications we’re already going to give them to prevent PONV, and that the combination will make the overall result more effective,” says Ms. Fraddosio. “They’re very responsive to that. I think patients are typically open-minded and generally willing to try something new that can improve their care.”

Aromatherapy is an amazing way to provide a wonderful environment for patients.
— Gerianne Fraddosio, MSN, RN, CNOR

Aromatherapy is part of BayCare’s larger strategy to augment traditional PONV medications and its overall efforts to provide patients with comfortable recoveries. Nurses lower the lights for patients in the PACU, offer eye patches or masks, and hand out ear buds that allow them listen to soothing music. “It’s important for us to provide patients with the best possible experience,” says Ms. Fraddosio. “In addition to being rewarded with good outcomes, we’re also met with gratitude for a thoughtful care plan that includes more than medications.”

The Lakeland (Fla.) Surgical & Diagnostic Center has been using aromatherapy to help its patients recover comfortably for a few years now. Clinical Director Nikki Williams, RN, CNOR, says the essential oils are effective in reducing PONV in about 75% of patients. “We’ve definitely had a good success rate with it,” notes Ms. Williams. “You’ll see patients with the little packets in their hand, or attached to their gowns, and they’ll keep putting it up to their noses every time they feel a wave of nausea.”

Lakeland sees the highest incidence of PONV in its female patients, particularly those who undergo breast lumpectomies. In those instances, when patients in a recovery bed are already vomiting, nurses will usually provide antiemetics. For patients who are “simply” nauseous, the nurses will generally suggest trying the aromatherapy before deciding whether additional medications are needed.

As is the case at BayCare, Ms. Williams says Lakeland’s use of aromatherapy is positively noted on patient satisfaction surveys, and the reviews are not only about the essential oils’ effectiveness in preventing PONV. “A lot of the comments are about how they feel aromatherapy is a very personal touch,” she says, “something that catered to their needs.” 

PONV is relatively common and can be caused by anesthesia or adverse reactions to other surgical medications. Anxiety can also be a factor. Increased pain, discomfort and PONV increase recovery times, and delayed discharges burden already taxed nursing staffs. They also increase the cost of care.

There’s also a human element to PONV prevention that Ms. Fraddosio says is very real. Merely offering patients something to calm their nerves and their stomach — over and above traditional medications — is helpful on its own. “There’s something very beneficial about the act of asking patients what else you can to do make them feel comfortable,” says Ms. Fraddosio. “It makes them feel cared for, which in turn makes them less anxious.”

Ms. Fraddosio has been involved in nursing for 30 years and believes in traditional medicine, but says such convictions shouldn’t preclude facilities from using additional alternative strategies. She thinks the use of essential oils is a great way to provide safe, cost-efficient, patient-centered care. “Aromatherapy isn’t dangerous, expensive or difficult to use,” says Ms. Fraddosio. “It’s an amazing way to create a wonderful environment for patients. I wasn’t an immediate believer, but I am now that I’ve seen the results.” OSM

Note: This three-part article series is supported by Soothing Scents.