Peter Veldhuis1, Maartje Melse2, Nieke Mullaart3. 1. Department of Emergency Medicine, OLVG Oost, Postbus 95500, 1090 HM, Amsterdam, The Netherlands. 2. Department of Emergency Medicine, Dijklander Ziekenhuis, Postbus 600, 1620 AR, Hoorn, The Netherlands. 3. Department of Emergency Medicine, Dijklander Ziekenhuis, Postbus 600, 1620 AR, Hoorn, The Netherlands. n.mullaart@westfriesgasthuis.nl.
Abstract
BACKGROUND: Nasal inhalation of isopropyl alcohol (IPA) seems an effective anti-emetic for the symptomatic treatment of nausea in the emergency department (ED) compared to conventional anti-emetics (Ondansetron and Metoclopramide). However, it is not yet known what the practical consequences are related to the use of IPA in the ED. OBJECTIVES: The purpose of this study was to assess the practical implications for patient care associated with IPA use and to evaluate the viability of permanent implementation of IPA inhalation as a first-line therapy for nausea in the ED. METHODS: We conducted a prospective, single-center implementation study comparing ED-based care for nauseated patients before (n=106) and after (n=104) the introduction of IPA. We evaluated the treatment process and cost and assessed implementation using a survey based on recommended implementation outcome measures. RESULTS: Comparing baseline phase to implementation phase, we found a significant increase in the percentage of patients receiving nausea treatment (66.0% versus 97.1%; p<0.001) and a reduction in time to treatment initiation (7 versus 1 min, p<0.001). Additionally, IPA introduction was associated with a decrease in the administration of conventional anti-emetics (0.52 versus 0.23 administrations per patient, p<0.001) and a notable drop in treatment cost (€1.33 versus €0.67 per patient). Nurses were content with IPA implementation and regarded definitive implementation as feasible and sustainable. CONCLUSION: Implementation of IPA as the first-line nausea treatment in the ED can increase the quality of care and improve care efficiency. Definitive implementation of IPA as a first-line treatment in the ED is both viable and practically feasible. TRIAL REGISTRATION: NTR, NL7717 , Registered on March 23, 2018 - Retrospectively registered.
BACKGROUND: Nasal inhalation of isopropyl alcohol (IPA) seems an effective anti-emetic for the symptomatic treatment of nausea in the emergency department (ED) compared to conventional anti-emetics (Ondansetron and Metoclopramide). However, it is not yet known what the practical consequences are related to the use of IPA in the ED. OBJECTIVES: The purpose of this study was to assess the practical implications for patient care associated with IPA use and to evaluate the viability of permanent implementation of IPA inhalation as a first-line therapy for nausea in the ED. METHODS: We conducted a prospective, single-center implementation study comparing ED-based care for nauseated patients before (n=106) and after (n=104) the introduction of IPA. We evaluated the treatment process and cost and assessed implementation using a survey based on recommended implementation outcome measures. RESULTS: Comparing baseline phase to implementation phase, we found a significant increase in the percentage of patients receiving nausea treatment (66.0% versus 97.1%; p<0.001) and a reduction in time to treatment initiation (7 versus 1 min, p<0.001). Additionally, IPA introduction was associated with a decrease in the administration of conventional anti-emetics (0.52 versus 0.23 administrations per patient, p<0.001) and a notable drop in treatment cost (€1.33 versus €0.67 per patient). Nurses were content with IPA implementation and regarded definitive implementation as feasible and sustainable. CONCLUSION: Implementation of IPA as the first-line nausea treatment in the ED can increase the quality of care and improve care efficiency. Definitive implementation of IPA as a first-line treatment in the ED is both viable and practically feasible. TRIAL REGISTRATION: NTR, NL7717 , Registered on March 23, 2018 - Retrospectively registered.
Entities:
Keywords:
Emergency department; Implementation outcome measures; Isopropyl alcohol inhalation; Nausea; Quality of care
Authors: Peter S Hussey; Han de Vries; John Romley; Margaret C Wang; Susan S Chen; Paul G Shekelle; Elizabeth A McGlynn Journal: Health Serv Res Date: 2009-01-28 Impact factor: 3.402
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