Akzeptanz einer Standard Operating Procedure (SOP) im stationären Setting am Beispiel der „SOP – Prophylaxe und Therapie von PONV (postoperative nausea and vomiting)“
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Philipps-Universität Marburg
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Postoperative nausea and vomiting are comparatively common, potentially preventable events that affect patient satisfaction and physical and economic outcomes. A sufficient decrease does not match the introduction of evidence-based PONV prophylaxis and therapy regimens in PONV incidence due to a lack of clinical implementation of the guidelines. To further minimize the incidence, the introduction of guidelines must be followed by controls of compliance and outcome. Such a review of the Marburg 'SOP - Prophylaxis and Therapy of PONV' has yet to occur. To check the acceptance of the SOP, data of 1216 patients concerning their PONV prophylaxis and therapy were analyzed and assessed concerning their SOP compliance and PONV occurrence (using the 'Simplified PONV Impact Scale' (SPIS) according to Myles & Wangritzky). Subsequently, semi-standardized interviews were conducted with the treating staff in the operating room and recovery room to investigate reasons for non-SOP-compliant actions and develop
optimization approaches.
The implementation of the Marburg SOP was comparatively frequent in the area of PONV prophylaxis. Nevertheless, every eighth prophylaxis did not meet the requirements of the SOP. Patients who received insufficient prophylaxis had a striking number of risk factors. In particular, risk factors that had to be assessed
by anamnesis, such as smoking status and positive travel sickness, increased the risk of undertreatment. In contrast, female gender, duration of surgery, or increased postoperative opioid requirements had a less significant influence. An explicit discipline at risk did not emerge. Patients in urology had a particularly low
risk of receiving insufficient prophylaxis. Patients who had received insufficient prophylaxis reported postoperative nausea and vomiting more frequently. In particular, patients at high risk were significantly
more likely to develop PONV symptoms if they received insufficient prophylaxis than patients with the same risk profile who received prophylaxis, according to SOP. The analysis of clinically relevant PONVs (SPIS ≥ 5) showed the same. Every third PONV therapy in the recovery room contained an antiemetic already
administered prophylactically. In most cases, this was Granisetron. Thus, these patients were treated less effectively and not in accordance with the SOP.
The interviews indicated the comparatively low SOP adherence in the recovery room. Two of the four interviewed nurses in the recovery room did not know the SOP. Another stated that she relied less on the SOP in her treatment planning and more on her years of experience. Re-introduction of the SOP and its evi-
dence-supported background in the context of an advanced training course could lead to increased compliance in this case. In addition, the SOP should be prominently displayed in the operating room and recovery room as a constant reminder. Generally, the content of the SOP was largely appreciated in the interviews. Primarily, the liberal content of the SOP gives the practitioners sufficient freedom in
planning prophylaxis and therapy, while the SOP lists available medications. Most importantly need for optimization regarding design and clarity was expressed. Therefore, the adaptation of the SOP layout to other internal clinical guidelines was requested. Additional recommendations, such as including relative contraindications, timing of drug application, or prioritization of antiemetics for PONV therapy, should be critically evaluated, especially considering the already poor overview of the SOP. In addition to (frequent) training, the introduction of individual feedback on the personal SOP adherence of the treating staff and resulting PONV incidences promises a further increase in SOP adherence in the operating room and recovery room. However, the considerable effort must be weighed against the potential benefits. Ensuring checklists is an alternative for increasing SOP adherence in the operating room, although it is not uncontroversial. Intervention studies should ideally accompany the introduction of such measures to test the effectiveness of
the respective method. The ongoing digitalization in healthcare offers further highly effective possibilities for increasing guideline compliance, such as the introduction of electronic reminder systems in the context of electronic anesthesia programs.
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Created: 2024Issued: 2025-02-12Updated: 2025-02-12
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Medizin
Publisher
Philipps-Universität Marburg
Language
ger
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DoctoralThesis
DFG-subjects
LeitlinienadhärenzSOPLeitlinieP6NVGuideline AdherenceGuidelinesPONV
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610
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Ritzhaupt, Hanna Erna Susanne: Akzeptanz einer Standard Operating Procedure (SOP) im stationären Setting am Beispiel der „SOP – Prophylaxe und Therapie von PONV (postoperative nausea and vomiting)“. : Philipps-Universität Marburg 2025-02-12. DOI: https://doi.org/10.17192/z2025.0022.