Acupressure for Post-Operative Nausea and Vomiting

The team began by identifying internal needs and assessing the hospital environment for readiness to implement acupressure for PONV.

Internal Needs Assessment

• Reviewed hospital practice guidelines for PONV management and confirmed that PONV affected 30-50% of surgical patients.
• Checked whether PONV incidence was charted in Recovery, ward, and pre-discharge observation charts. Found inconsistent documentation across care settings.
• Tracked current PONV incidence rates and rescue antiemetic usage using the PONV data extraction template. Confirmed that rescue antiemetic use was not equivalent to PONV incidence.
• Assessed PONV risk using the four primary risk factors: female gender, non-smoker status, prior PONV/motion sickness, and post-operative opioid use. Risk increases approximately 20% per additional factor (Apfel et al., 1999).

Intervention Selection

After reviewing all six modalities, the team selected acupressure wristbands for initial implementation based on:

• Strong evidence: nausea RR 0.60 (95% CI 0.53-0.69), vomiting RR 0.54 (95% CI 0.45-0.64)
• Low cost (~$5 AUD per unit, reusable)
• Minimal training requirement for nurses
• No infection risk (non-invasive)
• Capability for extended use and home continuation

Staff Survey

A survey of 165 doctors, nurses, midwives, and obstetricians at the hospital found:

• 42% believed acupuncture/acupressure was effective for PONV
• 81% would encourage patients to use it after receiving education
• 88% wanted further education on acupuncture/acupressure

Patient Perspectives

A survey of 160 surgical patients (Weeks et al., 2017) found that 65% would use acupuncture for PONV prior to education, increasing to 87% after receiving information. Only 15% of patients knew at baseline that acupuncture could treat nausea and vomiting.

Organisational Readiness

The team used the modified CARI tool (Barwick, 2011) to assess readiness across system readiness, senior leadership support, staff capability, plan maturity, and training needs (threshold: 80+ points out of 100).

With Exploration data in hand, the team developed strategies to leverage enablers and address identified barriers.

Feasibility Assessment

The team applied the FAME criteria (Pearson et al., 2005) — Feasibility, Appropriateness, Meaningfulness, and Effectiveness — and concluded that acupressure is a feasible, appropriate, meaningful, and effective intervention for PONV.

Timing

For prevention, wristbands were applied pre-operatively or immediately post-operatively in Recovery. For management, wristbands were applied after symptom onset. Timing was influenced by staff availability and surgical scheduling.

Patient Selection

High-risk PONV patients were prioritised: female, prior PONV/motion sickness history, non-smokers, and younger age. Surgery types with elevated risk (cholecystectomy, gynaecological, laparoscopic) were targeted first.

Document Preparation

• Revised hospital PONV guidelines to include acupressure
• Developed PONV checklists for clinical staff
• Created patient education materials
• Updated operative and ward documentation
• Modified drug charts to capture acupressure use

Barriers Addressed

1. Lack of awareness — addressed through education sessions and printed materials
2. Insufficient capability — addressed through training packages for each role
3. Equipment unavailability — addressed through procurement of wristband stock
4. Time constraints — addressed by demonstrating minimal application time

Implementation drew on both internal and external enablers, structured using CFIR constructs.

Organisational Structure

Because acupressure wristbands were used for 24 hours peri-surgically, staff from admission, theatre, recovery, and ward settings were all involved. Coordination and communication among those units was essential. All key stakeholders were included on the implementation team.

Implementation Strategies

Based on Grimshaw et al. (2012), the team used multiple strategies with known effectiveness:

Training

Three training packages were developed, differentiated by professional role, plus on-the-job training protocols. Training covered correct PC6 location, wristband application, monitoring, and documentation.

Execution Approach

The team followed a staged approach: practice runs first, then a pilot implementation in a single surgical unit, before expanding to additional units step by step.

Sustainability focused on normalising acupressure into routine operations so that practice persisted beyond the implementation team's active involvement.

Leadership Engagement

• Leadership engaged from initial phases
• Regular audit reports provided to leadership
• Outcomes aligned with organisational mission and quality objectives

Fidelity Monitoring

• Monitored correct wristband placement (preventing displacement below PC6)
• Onsite monitoring with staff feedback loops
• Visible, accessible education materials maintained in clinical areas
• Regular education sessions scheduled to match routine practice protocols

Staffing and Support

• Continuous staff support through education and available resources
• Enthusiastic champions identified per work unit
• Manager reminders integrated into existing communication channels

External Factors

• Cost assessment confirmed acupressure wristbands as cost-neutral to cost-saving (reduced rescue antiemetic use)
• Evidence of peer hospital interest as external motivation