When a patient experiences PONV in the PACU, don't automatically reach for an antiemetic agent. You first need to rule out other potential causes, such as abdominal obstruction or blood in the patient's stomach. Once you determine it's appropriate to administer an antiemetic agent, select an agent with a mechanism of action different from the agent you administered for prophylaxis. It's important to recognize that prophylaxis and treatment are distinct therapies. Serotonin antagonists have been extensively studied for both preventing and treating PONV. If a serotonin antagonist was administered for prevention of PONV, studies show that using it for treatment of PONV is no more effective than placebo. Also, limited literature suggests that doses of serotonin antagonists lower than those used for preventing PONV may be effective for treatment.
Andrew J. Donnelly, PharmD, MBA
Clinical Professor of Pharmacy Practice
University of Illinois Medical Center in Chicago
Hook them up once and forget it
Imagine the time you'd save if you didn't have to connect and reconnect vital signs monitors and leads to patients as they move through your facility. Once we attach the blood pressure cuff, heart monitor and pulse oximeter leads on patients in pre-op, we don't take them off until discharge. When patients arrive in the OR and in PACU, we simply plugs the leads into the monitors.
Kelly Trott Theodosopoulos, RN
Tuscarawas Surgery Center
Dry-erase board aids time-out
A dry erase board in your procedure rooms can help improve your compliance with the JCAHO-required time-out. Our boards display the patient's name, procedure (including side of the body, if applicable) and allergies. These categories are permanently written on labels attached to the board; the word "allergies" is written in black on red tape to make it stand out (the others are written in black on white tape). We can add other information, such as implants required. We determined that the circulator was the best choice to write the information on the board before each case. After induction but before the incision, the entire team calls the time-out. We review the name, planned procedure, allergies and other information and confirm it with the patient chart and OR schedule. We follow this procedure on every case, and it's worked so well that the radiology and special procedures departments have picked it up.
Denise Rouse, RN, MA, CNOR
Nurse educator, surgical services
St. Mary Medical Center
Quick fix to prevent wheel obstructions
Do you find that the tangle of electrical wires, cables, cords and hoses that run across your OR floor are constantly in the way, preventing carts and anesthesia machines from rolling freely? Here's a simple, inexpensive fix: Buy PVC tubing from your local hardware store, cut short lengths (4 inches to 6 inches) and put the tubing over the wheels of your carts; it'll easily push the cords out of the way. Best of all, you can do it for about $3 per pair.
Ron Shenker, CRNA, ARNP
Staff nurse anesthetist
Grants Pass Surgery Center
Grants Pass, Ore.
writeMail("[email protected]") Editor's note: You might also consider Castrgard devices to prevent wheel obstructions, designed and developed by an anesthesiologist and available in custom colors or special labeling. Call (888) 551-9700 or visit www.castrgard.com.
Make your own mailboxes
At our St. Louis-area hospital, our challenge was to distribute information to many staff members who work staggered shifts in various perioperative departments. Our solution: vertical wall-hanging magazine racks with individual slots. We purchased various sizes (from six slots [$20] to 25 slots [$85]) for all departments; the largest size only takes up 14 inches of wall space in width. These racks were easy to mount on the walls. We mounted them in staff lounges and dressing areas, and affixed each staffer's name label to his slot. We place all communication, staff-education packets or notices in each person's mailbox slot. Gone are the days of "I never got that" and "Nobody told me."
Kelly Hebel, RN, BSN
Alton Memorial Hospital