Post-operative nausea and vomiting is a common cause of patient dissatisfaction following anaesthesia. Audit of adherence to post-operative nausea and vomiting prevention guidelines is resource intensive when performed by manual chart extraction. Electronic audit can require costly anaesthetic and medical records. In our single site study, we sought to compare manual and electronic post-operative nausea and vomiting audits by utilising existing non-anaesthetic electronic medical records to avoid expensive additional software.
The audits were performed from 13 Jan 2020 to 01 Feb 2020 for surgical inpatients. Two post-operative nausea and vomiting periods were captured, the post anaesthetic recovery unit, and on the ward (to 24-hours). Electronic post-operative nausea and vomiting was defined as the administration of an antiemetic medication. A six-month electronic post-operative nausea and vomiting rate was also calculated.
Manual audit captured 142 patients, and electronic audit 294 patients, over the same time period. The manual post-operative nausea and vomiting rate was 10% (95%CI 5-16%) in the post anaesthetic recovery unit and 20% (95%CI 14-28%) the next day. The electronic rate was 5% (95%CI 3-8%) in the post anaesthetic recovery unit and 15% (11-19%) in a 24-hour period. The six-month electronic audit found 3510 patients, with a post anaesthetic recovery unit and 24-hour post-operative nausea and vomiting rates of 5% (4-6%) and 14% (13-16%) respectively. Electronic audit did not identify 5.8% of post-operative nausea and vomiting patients in the manual audit.
Electronic audit enrolled more patients and identified a lower post-operative nausea and vomiting rate than manual audit, likely from less enrolment bias. Electronic audit was easily repeated over a 6-month period. While electronic post-operative nausea and vomiting audit is possible without additional software, an electronic anaesthetic chart would greatly improve audit quality.