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Old Science, New Angle Prevent Nausea

CancerWise - April 2009


By Bayan Raji

A team of doctors at M. D. Anderson is combining common scientific knowledge with a new approach to prevent postoperative nausea and vomiting (PONV), a common side effect after anesthesia and surgery.

“This is not about novel drugs or the science, which is different from what you usually hear,” says John Frenzel, M.D., associate professor in the Department of Anesthesiology and Pain Medicine at M. D. Anderson. “The medicines we’re using are already well known, and the method is effective from both cost and treatment perspectives.”

As a bonus, the method lowers medical expenses for patients. It also provides a new way to give feedback to physicians, allowing them to compare their nausea-prevention methods and outcomes to those of other physicians.

Prevention is key

As part of the pre-surgery evaluation, each patient meets with an anesthesiologist. At that time, risk for PONV is assessed.

Patients at higher risk for developing PONV are:

  • Females
  • Nonsmokers
  • Those with a history of motion sickness or PONV

High-risk patients are given multiple anti-emetic (anti-vomiting) drugs during surgery to help prevent PONV in the recovery room, rather than waiting until the symptoms occur.

Less-expensive medicines can be effective

The choice of agents to treat PONV is important. Part of Frenzel’s work has been to identify effective combinations of less-costly generic medicines that can take the place of more expensive trade brands. Each patient is different, and a range of effective choices is available for each risk group.

Preventing PONV improves care, enabling patients to recover from surgery without nausea. Studies show that preventing PONV also improves patients’ perceptions of their hospital experiences.

“After a procedure, a patient already is feeling so many different emotions,” Frenzel says. “To add PONV on top of that makes it all worse. Anything we can do to optimize the treatment of the patient and reduce the risk resonates with us.”

Method aids implementation

The treatment of PONV is well understood. The science, the medications and the practice guidelines are all known. But, consistent practice and application of the guidelines are more difficult to ensure.

To help understand how change takes place in medical practice, Frenzel and his colleagues are using prevention of PONV as a model.

“PONV is a useful model to study how new information can be incorporated into everyday medical practice,” Frenzel says. “Medical science is changing quickly, but the ability to consistently incorporate these changes into physicians’ practices takes years. Unless the development is truly groundbreaking, providers adopt science slowly, even when it’s well known.”

Behaviors can be changed

Change in knowledge may be fairly painless, but change in behavior often is more difficult, Frenzel says. Behavior is what people actually do, and they often need a mirror to see that.

In this case, the mirrors are practice reports from an electronic database of patient anesthesia records. Looking at these records, doctors can see how effective their PONV prevention efforts are, as well as compare their compliance statistics with the published guidelines and the practices of other doctors.

“When we gave physicians data on their behavior, compliance increased dramatically,” Frenzel says. “We are giving people a mirror so they can see how they are actually doing.”

By giving doctors the knowledge to improve care and providing feedback that lets them know how they are doing, Frenzel’s team has noticed a dramatic increase in guideline compliance to more than 80%.

Mirror may have a future

Looking into the future, Frenzel says the method of using practice data to change behavior also could be used to help doctors more rapidly implement other guidelines, such as the treatment of postoperative pain or maintenance of patient temperature during surgery.

“Our goal is to use the science and medicine we already know in a consistent way to benefit our patients and give them the best outcomes possible,” he says.

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© 2014 The University of Texas MD Anderson Cancer Center