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Herbal product use and perioperative patients

AORN Journal, May, 2004 by Cheryl MacKichan, Jacklyn Ruthman

The article "Herbal product use and perioperative patients" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is May 31, 2007.

Complete the examination answer sheet and learner evaluation found on pages 963-964 and mail with appropriate fee to

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or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on the effect of herbal product use on perioperative patients, the nurse will be able to

(1) explain how the historical use of herbal remedies affects herbal medicine practice today,

(2.) identify regulatory guidelines that affect marketing of herbal products,

(3.) discuss the process of herbal product preparation, and

(4.) describe the perioperative implications of herbs that are used preoperatively.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

A minimum score of 70% on the multiple-choice examination is necessary to earn 2.6 contact hours for this independent study.

Purpose/Goal: To educate perioperative nurses about the effects of herbal product use on perioperative patients.

The increased use of herbal products and the paucity of scientific data on these alternative medications present a special challenge when providing perioperative care. This is especially true for perioperative team members who may not be knowledgeable about alternative medication use in patients undergoing a surgical procedure. This group of patients may be at risk for herbal medication interactions with anesthetic agents and other medications during the surgical procedure. In the context of this literature review, the terms herbal medications, herbal products, herbal remedies, dietary supplements, and alternative medications are used interchangeably. The term health care provider includes physicians, advanced practice nurses, physician's assistants, and perioperative nurses.

ANALYSIS OF THE PROBLEM

Use of herbal products in the United States has increased as much as 380% in the past decade. (1) In 1997, approximately 15 million Americans (ie, one in five individuals) used herbal products or high-dose dietary supplements in combination with prescription medications. One in six patients may be taking herbal products in addition to prescribed treatments. (2) Studies of herbal product use in the preoperative patient population have found that more than 32% of perioperative patients use herbal preparations and other dietary supplements or both. (3-6)

Today, approximately 1,200 to 1,800 herbal products are marketed internationally. (7,8) In the United States, approximately $3 billion to $5 billion is spent on herbal products annually by consumers. (1,8-10) The World Health Organization (WHO) reports that approximately 75% of the world's population "depends on botanical medicines for their basic health care needs." (11) (p41) In its review of the literature, the WHO also reports that 121 prescription medications currently used worldwide are produced directly from plant extracts. Most recently, the discovery of an antineoplastic medication called paclitaxel, which is derived from the Pacific yew tree, underscores the importance of the role that plants play in modern pharmacotherapy. (12)

Awareness of herbal products has increased because of mass marketing via media advertisements. The main sources of information about herbal remedies for women who are 65 years of age and older are magazines, television, and newsletters. (13) Access to herbal remedies also has increased during the past decade. Many herbal products that, at one time, only were available in health food stores or from herbalists now are available in many pharmacies, as well as in grocery and retail stores. (14-16)

Today, consumers often attempt to diagnose their own ailments and seek treatments that are easier to obtain than conventional therapies. With the ease of access to herbal products, consumers can obtain information about herbs via word of mouth from friends and family members, by consulting a sales clerk in a nutrition or herbal store, and on the Internet. (2,14)

In studies that reported an increase in herbal product use, a large percentage of patients did not inform their health care providers about herbal product or dietary supplement use. (1,3,4,6) Health care providers who were not informed about herbal product use included primary care physicians and anesthesia care providers. (3,4,6) Not informing their health care providers about herbal product use puts patients at risk for avoidable herb-medication interactions that could be lethal. During routine preoperative assessment of patients awaiting surgery, health care providers must ask about use of herbal and dietary supplements.

Health Care Industry

Herbal product use and perioperative patients

AORN Journal, May, 2004 by Cheryl MacKichan, Jacklyn Ruthman

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