• Usman Ali, Maisie Tsang, Brenda Igbeyi, Sindu Balakrishnan, Kelly Shackell, Gloria Kotzer, and Conor Mc Donnell.
• Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
• Paediatr Anaesth. 2019 Jul 1; 29 (7): 690-697.

BackgroundPost-operative nausea and vomiting is a significant cause of morbidity in pediatric anesthesia. As well as patient discomfort, post-operative nausea and vomiting can also result in dehydration, delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high risk group for post-operative nausea and vomiting.AimsThe aim of this project was to reduce post-operative nausea and vomiting by 50% over a period of 12 months.MethodsThis was a single centre retrospective observational study, with prospective observational follow up. A driver diagram was constructed and smart aim established. The Plan-Do-Study-Act method of quality improvement was used for this project. Benchmark data from one hundred patients was collected retrospectively from patient records. After this, interventions were introduced and serial data was prospectively collected. Statistical process control charts were constructed to monitor percentage bundle compliance and incidence of post-operative nausea and vomiting in the post anesthetic care unit.ResultsPost-operative nausea and vomiting data was collected for 1079 children in total. Baseline incidence of post-operative nausea and vomiting was 18%. After 4 years this was reduced to 4.72%. At the conclusion of the project there was no significant difference over the previous six months between the incidence of post-operative nausea and vomiting in the strabismus population and the general post anesthetic care unit population.ConclusionUsing quality improvement methodology, we were able to sustainably reduce the incidence of post-operative nausea and vomiting for children undergoing strabismus repair. We demonstrated using an evidence based therapeutic bundle can reduce incidence of post-operative nausea and vomiting in the high risk surgical strabismus population to a level comparable to the average post-operative nausea and vomiting incidence in our post anesthetic care unit population.© 2019 John Wiley & Sons Ltd.

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