This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.
Percentage of patients, aged 18 years and older, who undergo a procedure under an inhalational general anesthetic, AND who have three or more risk factors for post-operative nausea and vomiting (PONV), who receive combination therapy consisting of at least two prophylactic pharmacologic antiemetic agents of different classes preoperatively or intraoperatively.
The purpose of this process of care measure is to reduce the incidence of postoperative nausea and vomiting in adult surgical patients.
Preop through Recovery Room In
Patient receives combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively or intraoperatively
Anti-emetic therapy: The recommended first- and second-line classes of pharmacologic anti-emetics for PONV prophylaxis in patients at moderate to severe risk of PONV include (but are not limited to):
Note: In addition, propofol infusion is accepted as one of the antiemetic options for this measure. The foregoing list of medications/drug names is based on clinical guidelines and other evidence. The specified drugs were selected based on the strength of evidence for their clinical effectiveness. This list of selected drugs may not be current. Physicians and other health care professionals should refer to the FDA’s web site page entitled “Drug Safety Communications” for up-to-date drug recall and alert information when prescribing medications.
Provider(s) signed in at Induction End.
Method for determining Responsible Provider:
General Inhalational Anesthetic MPOG Concept IDs |
||
3297 |
Enflurane Exp % |
|
3298 |
Enflurane Insp % |
|
3006 |
Isoflurane actual consumption (ml) |
|
3007 |
Desflurane actual consumption (ml) |
|
3260 |
Isoflurane Exp % |
|
3265 |
Isoflurane Insp% |
|
3280 |
Desflurane Exp % |
|
3285 |
Desflurane Insp % |
|
50420 |
Cardiopulmonary bypass – Isoflurane vaporizer turned on |
|
3008 |
Sevoflurane actual consumption (ml) |
|
3270 |
Sevoflurane Exp % |
|
3275 |
Sevoflurane Insp % |
|
3503 |
Sevoflurane (mmHg) |
|
3250 |
Nitrous Insp % |
|
3255 |
Nitrous Exp % |
|
Antiemetic MPOG Concept IDs (by class) |
||
Class: 5-Hydroxytryptamine (5-HT3) Receptor Antagonists |
||
10335 |
Ondansetron |
|
10164 |
Dolasetron |
|
10208 |
Granisetron |
|
10711 |
Palonosetron |
|
Anticholinergics |
||
10400 |
Scopolamine Patch |
|
10399 |
Scopolamine |
|
11040 |
Butylscopolamine |
|
Antiemetic MPOG Concept IDs (by class)- Continued |
||
Antihistamines |
||
10257 |
Dimenhydrinate |
|
10160 |
Diphenhydramine |
|
10635 | Meclizine | |
Butyrophenones |
||
10169 |
Droperidol |
|
10210 |
Haloperidol |
|
Neurokinin-1 Receptor Agonists |
||
10035 |
Aprepitant |
|
10719 |
Fosaprepitant |
|
Phenothiazines |
||
10374 |
Promethazine |
|
10373 |
Prochlorperazine |
|
Steroids |
||
10147 |
Dexamethasone |
|
10296 |
Methylprednisolone |
|
Prokinetic |
||
10297 |
Metoclopramide |
|
Other |
||
10377 |
Propofol (Infusion only) |
|
PONV Medical Reason Exclusion MPOG Concept ID |
||
50046 |
Medical Performance Exclusion- PONV |
|
PONV Risk Factor- Smoking Status MPOG Concept IDs: |
||
70128 |
History- Social History- Tobacco |
|
71100 |
History- Social History- Tobacco Details Pack Years |
|
71110 |
History- Social History- Tobacco details Current vs Past |
|
PONV Risk Factor- History of PONV/Motion Sickness MPOG Concept IDs: |
||
70225 |
Assessment and Plan - Comments |
|
70302 |
Assessment and Plan- Anesthetic Consideration |
|
70338 |
General- PONV Risk Factors |
|
70339 |
General- PONV Risk Total Score |
|
70080 |
General- Previous Anesthetic Problem |
|
70102 |
Misc- Motion Sickness |
|
PONV Risk Factor- Intended Administration of Opioids for Postop Analgesia MPOG Concept IDs: |
||
70234 |
Assessment and Plan – Postop Pain Management |
|
10008 |
Bupivacaine w/ Hydromorphone 0.1% / Unspecified |
|
10020 |
Alfentanil |
|
10077 |
Bupivacaine w/ Fentanyl 0.0625% / 3 mcg/mL |
|
10079 |
Bupivacaine w/ Fentanyl 0.08% / 2 mcg/mL |
|
10080 |
Bupivacaine w/ Fentanyl 0.125% / 2 mcg/mL |
|
10081 |
Bupivacaine w/ Fentanyl 0.125% / 3 mcg/mL |
|
10082 |
Bupivacaine w/ Hydromorphone 0.0625% / 5 mcg/mL |
|
10083 |
Bupivacaine w/ Hydromorphone 0.0625% / 10 mcg/mL |
|
10103 |
Bupivacaine w/ Fentanyl 0.125% / 5 mcg/mL |
|
10186 |
Fentanyl |
|
10187 |
Fentanyl / Midazolam 40mcg/mL / 200mcg/mL |
|
10219 |
Hydromorphone |
|
10258 |
Bupivacaine w/ Hydromorphone 0.05% / 3 mcg/mL |
|
10279 |
Meperidine |
|
10290 |
Methadone |
|
10306 |
Morphine |
|
10341 |
Oxycodone |
|
10408 |
Bupivacaine w/ Fentanyl 0.0625% / 5 mcg/mL |
|
10414 |
Sufentanil |
|
10439 |
Bupivacaine w/ Sufentanil w/ Epinephrine 100 mg / 100 mcg / 0.42 mg |
|
10475 |
Bupivacaine w/ Hydromorphone 0.125% / 5 mcg/mL |
|
10476 |
Bupivacaine w/ Hydromorphone 0.125% / 10 mcg/mL |
|
10478 |
Lidocaine w/ Hydromorphone 2% / 10 mcg/mL |
|
10479 |
Lidocaine w/ Fentanyl w/ Epinephrine w/ Bicarbonate 2% / 5 mcg/mL / 1:200,000 |
|
10481 |
Oxycodone / Acetaminophen 5 mg / 325 mg |
|
10482 |
Hydrocodone / Acetaminophen 5 mg / 325 mg |
|
10483 |
Hydrocodone / Acetaminophen 7.5 mg / 500 mg |
|
10486 |
Bupivacaine w/ Fentanyl 0.5% / 3 mcg/mL |
|
10488 |
Bupivacaine w/ Fentanyl 0.5% / 10 mcg/mL |
|
10518 |
Bupivacaine w/ Hydromorphone 0.5% / 10 mcg/mL |
|
10519 |
Bupivacaine w/ Fentanyl 0.05% / 3 mcg/mL |
|
10522 |
Bupivacaine w/ Morphine 0.75% / 0.2 mg |
|
10534 |
Bupivacaine w/ Fentanyl 0.0625% / 2 mcg/mL |
|
10536 |
Bupivacaine w/ Fentanyl 0.0625% / 10 mcg/mL |
|
10554 |
Bupivacaine w/ Fentanyl 0.1% / 2 mcg/mL |
|
10583 |
Bupivacaine w/ Fentanyl 0.0625% / 4 mcg/mL |
|
10584 |
Bupivacaine w/ Fentanyl 0.0625% / 10 mcg/mL |
|
10585 |
Bupivacaine w/ Fentanyl 0.125% / 4 mcg/mL |
|
10597 |
Propofol w/ Alfentanil 10 mg/mL + 50 mcg/mL |
|
10603 |
Bupivacaine w/ Hydromorphone 0.05% / 10 mcg/mL |
|
10611 |
Bupivacaine w/ Fentanyl w/ Epinephrine 37.5 mg / 750 mcg / 0.125 mg |
|
10620 |
Bupivacaine w/ Fentanyl 0.125% / 10 mcg/mL |
|
10633 |
Ropivacaine w/ Fentanyl 0.125% 2 mcg/mL |
|
10642 |
Bupivacaine w/ Fentanyl 0.01% / 4 mcg/mL |
|
10643 |
Bupivacaine w/ Fentanyl 0.25% / 4 mcg/mL |
|
10644 |
Bupivacaine w/ Fentanyl 0.25% / 2 mcg/mL |
|
10646 |
Bupivacaine w/ Hydromorphone 0.125% / 20 mcg/mL |
|
10648 |
Bupivacaine w/ Hydromorphone 0.1% / 20 mcg/mL |
|
10654 |
Bupivacaine w/ Fentanyl 0.167% / 16.67 mcg/mL |
|
10669 |
Bupivacaine w/ Fentanyl 0.25% / 10 mcg/mL |
|
11120 |
Bupivacaine w/ Fentanyl 0.05% / 5 mcg/mL |
|
11130 |
Bupivacaine w/ Fentanyl 0.25% / 2.5 mcg/mL |
|
11140 |
Bupivacaine w/ Fentanyl 0.05% / 2 mcg/mL |
Postoperative nausea and vomiting (PONV) is a common and unpleasant outcome of anesthesia care that can lead to other complications, lengthening the patient’s recovery period after surgery1. Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period.2 The Apfel score is one of the most common risk predictors for PONV and is based on 4 variables: female gender, nonsmoking status, history of PONV or motion sickness and postoperative opioid administration. The presence of each additional risk factor increases a patients risk of PONV by twenty percent.3 Although including a prophylactic anti-emetic administration protocol that considers such risk factors has shown to reduce the incidence of PONV, there is high variability in this outcome.4-7