By Jennifer Thew, RN
Nausea, vomiting, and abdominal pain are common reasons for patients to visit the emergency department. A 2014 statistical brief from the Healthcare Cost and Utilization Project, reports that in 2011, abdominal pain accounted for 5.6 million visits to the ED.
Unfortunately, there aren't many preemptive interventions, besides giving the patient nothing by mouth, that nurses can quickly implement to give patients relief from these symptoms.
"As a nurse you feel bad," says Katie Morse, RN, BSN, CEN, TCRN, supervisor and trauma coordinator at CHI Health Mercy Council Bluffs, in Council Bluffs, Iowa. "It’s almost like you're helpless against those complaints even though they're very common things that people are coming into the hospital with and it's discomforting for patients."
But in spring 2018, the nursing staff tried something new to help patients with nausea, vomiting, or abdominal pain find more immediate relief from their issues—essential oils.
And they experienced success, particularly in seeing a 26-minute drop in the time it took for patients to receive an intervention for these complaints.
In the past, "It was taking about 43 minutes from arrival for the patients to get something for the nausea," Morse says. "After we started using [the essential oil blend], we noted our median time was about 17 minutes."
Here's how the implementation project worked.
Why Essential Oils?
Morse says the idea came from the organization's shared governance committee because one of the nurses had experience using essential oils for nausea and vomiting in the surgical setting.
"We started looking at some of the research that's out there about essential oil use. It's often used in surgery and has been used in acute care settings, but we really couldn't find anything out there about using it in the emergency department," she says. "We wanted to explore it because we're patient satisfaction–focused," Morse says.
Based on this, the nurses thought it would be worth trying.
"It's a low-risk type intervention. We think about it like giving ice for someone with ankle injury," she explains. "That's something we'd get going right away for a patient even if they're not going back to a room right away. We felt like this would be a good nursing intervention that we could start carrying out."
Time Is of the Essence
For the implementation project, the team decided to track if there was a decrease between the time the patient arrived at the healthcare facility and the time he or she received an intervention for nausea, vomiting, or abdominal pain.
"We wanted to try something that was non-pharmacologic that could be nurse-initiated and started right away and to see if it would make a difference in the time from patient arrival to the hospital to the intervention being given," Morse says, pointing out that no physician order is needed to administer essential oils.
The triage nurses began offering the essential oils upon first meeting patients with these symptoms. At CHI Health Mercy Council Bluffs, during designated high-volume times, a triage nurse is stationed in the hospital lobby to meet the patients.
"The first person those patients are coming into contact with is a nurse, so treatment with essential oils blend could initially start there," Morse says.
The nurse offers patients with stomach issues an individual packet of QueaseEASE—a commercially available blend of lavender, ginger, peppermint, and spearmint essential oils—to inhale.
Additionally, once a patient was admitted to an ED room, nurses could offer it there as well. The packet lasts for 72 hours and patients can take it home with them.
Besides the significant drop in time to intervention once the essential oils became available, a retrospective chart review found there was documented improvement of symptoms in about 50% of patients who used the treatment. Fifty-two patients received the intervention over the one-month project.
Interestingly, a 2016 study published in the Annals of Emergency Medicine found that compared to patients who smelled a placebo of saline solution, patients who smelled isopropyl alcohol reported greater relief from nausea.
As for the nurses:
- 63% indicated they saw value in having the oil blend available as a resource
- 75% thought it was beneficial and that it may have a positive impact on patient experience
Though this was strictly an implementation project, Morse says, the topic warrants further study.
"We realize we need to explore [this] further," she says. "There's a lot of potential benefit and still a lot of questions with this. More research is definitely needed."
For example, Morse says they need to delve into whether patients felt they did not need antiemetics after essential oil use, or comparing its cost effectiveness to pharmacologic interventions.
The project has garnered some interest from nurse leaders. The Iowa Organization of Nurse Leaders selected it as the winner of its Innovation in Patient Care Award from among 20 nominations.
Morse encourages other nurses to use patient experience as a driver to create new ways to deliver care.
"If you're interested in something explore it, get information together, and then take it to leadership," she says. "Anything that [clinicians] in healthcare can do to help with the patient experience and make positive patient experiences with every encounter… is the most rewarding aspect of being a nurse."