THE IMPACT OF AUDIT IN A DISTRICT GENERAL-HOSPITAL ON POSTOPERATIVE NAUSEA AND VOMITING AFTER MAJOR GYNECOLOGICAL SURGERY

An audit of post-operative nausea and vomiting (PONV) was undertaken i n 935 female patients who used morphine patient-controlled analgesia ( PCA) for pain relief after major gynaecological operations in a distri ct general hospital. We investigated retrospectively five different an tiemetic policies and a reference group without policy from January 19 93 to July 1995. The department's computerized audit system was used t o analyse the observations. At the beginning of the audit, the inciden ce of nausea and vomiting was as high as 71.5%. But as a consequence o f this audit, a departmental policy was adopted 3 years later, which h ad an incidence of PONV of only 51.7%. During this time the compliance with antiemetic protocols increased from 41% to 76%. There was signif icantly less PONV if an antiemetic protocol was followed (P=0.002). Th is emphasizes the importance of corporate involvement in the developme nt, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significan tly irrespective of the type of antiemetic drug used.