Download Full Text (588 KB)

Publication Date



2021 prov rn poster, 2021 prov rn tx, texas, lubbock, covenant


Nursing | Perioperative, Operating Room and Surgical Nursing


Background: Postoperative nausea and vomiting (PONV) continues to be a perioperative complication despite improvement in quality and safety of anesthesia care causing an increased overall healthcare cost and sometimes serious physical complications. The American Society of PeriAnesthesia Nurses (ASPAN) supports that risk assessment for PONV helps with its prevention which is in line with the Society of Ambulatory Anesthesia's (SAMBA) current guidelines for PONV management. Literature supports that PONV can be predicted and prevented in patients by assessing risk factors such as gender, smoking status, history of PONV and use of postoperative opioids, among others. At present there is no formal PONV risk assessment tool that will help the perioperative team prevent this unpleasant complication from surgery.

Purpose: The purpose of the study is to determine the effectiveness of APFEL Simplified Risk Score (SRS) in predicting PONV and apply this tool to help prevent PONV in patients undergoing surgery.

Methods: A group of nurses conducted a quality improvement study in the adult day surgery unit of a tertiary hospital in northwestern Texas was done from May 7, 2019 to August 2, 2019. The APFEL SRS (a PONV risk assessment tool) was used in the study because of its practicality and literature-supported effectiveness. A form was devised consisting of patient's APFEL SRS score from 0-4 (0 = no PONV risk, 1 = low PONV risk, 2 = moderate PONV risk and 3-4 = high PONV risk). A list of medications received before, during and after surgery including anesthesia, pain medicines and antiemetics and record of PONV experience after surgery and 24 hours post discharge was also collected. APFEL SRS scores were compared to the likelihood of developing PONV.

Results: A total of 474 patients who received general anesthesia and discharged the same day was included in the study. 17% of patients had an APFEL SRS of 1, 40% with APFEL SRS of 2, 34% with APFEL SRS of 3 and 9% with APFEL SRS of 4. The patients' experience of PONV increased as their risk scores went up. Data showed 18% PONV experience in patients with APFEL SRS of 1, 17% in APFELSRS of 2, 30% in APFEL SRS of 3 and 49% in APFEL SRS of 4. The results showed that the use of prophylaxis drugs for PONV did not correlate with APFEL SRS scores. It was noted that patients with higher APFEL SRS scores also received more narcotics.

Conclusion: The use of APFEL SRS is effective in predicting PONV and awareness of the patient's PONV risk will help the perioperative team prevent and manage its care.

Implications for practice: Since nurses are in position to assess the PONV risk of the patients, adapting APFEL SRS tool will ease the communication of the risk to the anesthesia and surgical team. Awareness of the patient's risk will help doctors do their part in preventing and treating PONV, whereas nurses can use nonpharmacological interventions an





Conference / Event Name

2021 Providence RN Conference


Virtual Conference

Effectiveness of Apfel Simplified Risk Score in Predicting Postoperative Nausea and Vomiting in Day Surgery Unit