Non-pharmacological option for self-administered nausea relief in the pediatric ED: Essential oil blend aromatic inhaler

Abstract

<p>Poster presentation Session F presented Friday, September 15, 2017</p> <p><strong>Purpose:</strong> Our staff wanted to offer a non-pharmacological option for nausea that is self-administered/controlled, nurse directed without continued nursing supervision, and has no limit /maximum use/frequency. Although QueaseEASE (QE) is widely used in labor/delivery, adult PACU, and adult/pediatric HemOnc areas; QueaseEASE has little previous use in pediatric or adult emergency departments.</p> <p><strong>Design:</strong> The staff developed project compared standard pharmacological nausea relief usage before and after patients' self directed use of QueaseEASE. Cost analysis and patient satisfaction were trended.</p> <p><strong>Setting:</strong> The study occurred in the public academic health center/research university level one trauma center pediatric emergency department.</p> <p><strong>Participants/Subjects:</strong> Inclusion criteria: Any patient 2yrs and older that has not received Zofran within 30 minutes of presentation complaining of nausea. Exclusion criteria: Any mechanical or obstructive pathophysiology (appendicitis, bowel obstruction, intussusception etc.).</p> <p><strong>Methods:</strong> After obtaining verbal consent from the patient/family, QE is demonstrated by the staff member. QE is left with the patient /family to self-administer. Patients, families or staff may halt the trial at any time. If no resolution of nausea occurs within 30 minutes, other measures are offered. Staff (RN) and patient/family (PT) complete a survey after the trial is completed/stopped. Utilization review of standard treatments were noted before and after the study.</p> <p><strong>Results/Outcomes:</strong> 40 cases total: males 38%, females 62%; Shifts: days 45%, evenings 40%, nights 15%; <br />Ages: 17mo (per mom&rsquo;s request)-1, 2-4yo-10%, 5-7yo-10%, 8-10yo-18%, 11-13yo-13%, 14-16yo-28%, 17-19yo-20%. Chief complaints: Neuro: syncope, HA, TBI, CHI; Cardiac/Resp: asthma, CP, CF, pneumonia, pneumothorax; GI/GU: abd pain, kidney stones, DM, constipation, IUP, menses, ovarian cyst, UC, C diff complications; ENT: eye pain, sore throat; Musculoskeletal/skin: fractures, abscess; Other: HemOnc port concerns, drug/alcohol ingestions, anxiety, suicide gestures/ideation, depression.</p> <p>Results of surveys (RN=nurse response, PT=patient/family response): Nausea reduced/eliminated 74% RN , 79% PT; Family satisfied 76% RN; Trial stopped at family request 10% (due to smell); Trial stopped due to nursing judgement 14% (60% patient not like the smell, 40% patient started vomiting); Additional interventions required 37% (Of which 75% patients still satisfied with QE, Of which 64% patients would still request QE first); Zofran/IVF 36%, Ativan 14%, Narcotic or pain med14%, IVF alone 28%, other antiemetic 7%; Patient would request QE again 79%PT (NOTE: not all survey questions were answered by all patients-percentages are from the answers given -so spreads are not always100%).</p> <p><strong>Implications:</strong> Due to our small daily census (30-50) and exclusion criteria, the sample size is small (40) and over a 2-3month period. Girls were enrolled twice as often as boys. Teens were enrolled twice as often as school age. One 17mo was included per mom&rsquo;s request due to her concurrent use of home essential oils during the triage. In spite of our small sample size, we had a broad representation of pediatric emergency department chief complaints. Overall patients and families were very satisfied with QueaseEASE (76%) and would request it again (79%). A year after QueaseEASE was approved for use in the pediatric emergency department, QueaseEASE is still frequently offered to school age and older patients with nausea and stress/anxiety related issues.</p>