Drug Use Evaluation of Ondansetron in Postoperative Nausea and Vomiting

ABSTRACT Background Postoperative nausea and vomiting (PONV) may prolong patient recovery time and increase the cost of their care. Ondansetron is an effective treatment for PONV, but is more expensive than other antiemetics. The Auckland District Health Board (ADHB) PONV guidelines are a stepwise approach to anti‐emetic prescribing in which ondansetron is the last choice. Aim To investigate the patterns of ondansetron prescribing in the management of PONV at Auckland City Hospital and whether its use was in accordance with the ADHB PONV guidelines. Method A retrospective drug use evaluation of patients for whom ondansetron was prescribed, and who were admitted postoperatively to 20 adult medical and surgical wards. Results 303 patients were recruited over a 4‐week period, of whom 256 surgical patients were considered. Adherence with the ADHB PONV guidelines was higher when a reminder (an antiemetic sticker) was used than when it was not used (84% vs 76%). Use of the sticker increased the proportion of patients for whom other anti‐emetics were prescribed. There was poor identification of patients at risk of PONV and consequently limited use of prophylactic antiemetics in this group. Conclusion Although the use of antiemetic stickers was low, overall adherence to the ADHB PONV guidelines was encouraging. A number of steps were often omitted when an antiemetic sticker was not used and a significant proportion of patients received ondansetron first‐line.