PONV unplugged

Dynamic tools that allow for free flow of information between the various stakeholders in PONV management need to be developed. Claybon et al, through PONV Therapeutic Decision Support Modules (TDSMs), have attempted to create a system that combines recommended PONV guidelines and allows for individual practice assessment of drug utilization and pharmacoeconomic determination. Figure 2 (a and b) represents a two-step pilot model tracking system for PONV TDSM. All relative risk information is collected preoperatively and recorded so that the various members of the multidisciplinary team can easily access the information. The patient or a member of the team can perform this task. Next, the prescribed prophylactic regimen is recorded. This provides some insight into the decision-making processes and helps determine proper utilization (over- or underutilization). During the operative period, additional pertinent information is recorded on the module. When the patient reaches the recovery room, the information is reviewed by the team and any additional treatments are noted. This is a basic model and needs to be validated, but has the ability to provide prospective insight into the decision-making process and management of the patient. It allows for both respective and prospective consideration for pharmacoeconomic evaluation and ultimately the ability to better define PONV practice performance metrics. The concept is interesting and the value of this tool needs to be explored further. As a profession, we have to start thinking outside the box, getting our clinical pharmacists, perioperative nurses, and surgical colleagues more involved, and assuming the role of perioperative consultant for post-discharge nausea and vomiting. Tools like TDSMs and formalized society based guidelines are the first step toward achieving reductions in PONV in a cost-effective manner through evidence-based practice.