Measure Abbreviation
PONV-03
Data Collection Method

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.

Measure Type
Outcome
Description

PONV 03: Percentage of patients, regardless of age, who undergo a procedure and have a documented nausea/emesis occurrence OR receive a rescue antiemetic in the immediate postoperative period.

PONV 03b: Percentage of patients, regardless of age who undergo a procedure and have a documented nausea/emesis occurrence with or without receiving an antiemetic in the immediate postoperative period.

 

Measure Time Period

Recovery Room In through 6 hours after Anesthesia End

Inclusions
  • All patients, regardless of age, who undergo any procedure including surgical, therapeutic, or diagnostic requiring care by anesthesia providers.
  • C-Sections (CPT: 01961, 01968)
  • Labor Epidurals converted to C-Section (Cases with both CPT: 01967 and 01968)
Exclusions
  • Patients transferred directly to the ICU
  • Organ Harvest (CPT: 01990)
  • Liver Transplant Surgery (CPT: 00796, 47135, 47136)
  • Labor Epidurals (CPT: 01967, 01958, 01960)
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
Success

Patient does not report nausea, have an emesis event or receive an antiemetic during the immediate postoperative period.

Other Measure Build Details

Algorithm for determining Measure Start Time:

  1. Recovery Room In Date/Time. If not available then,
  2. Phase I Recovery Room In Date/Time. If not available then,
  3. Phase II Recovery Room In Date/Time. If not available then,
  4. Patient out of Room. If not available then,
  5. Data Capture End. If not available then,
  6. Anesthesia End.

*If Patient out of Room is used as Measure Start, the measure will begin 1 minute after Measure Start time.

Algorithm for determining Case Duration:

Case Start:

  1. Anesthesia Induction End. If not available, then
  2. Anesthesia Induction Begin. If not available, then
  3. Procedure Start. If not available, then
  4. Patient in Room. If not available, then
  5. Anesthesia Start

Case End:

  1. Patient Extubated. If not available, then
  2. Procedure End. If not available, then
  3. Patient Out of Room. If not available, then
  4. Anesthesia End
Responsible Provider

All providers for a given case who are signed in ≥ 40 minutes. If a given case is ≤ 60 minutes, all providers are responsible.

Threshold
5%
MPOG Concept IDs Required

Antiemetic MPOG Concept IDs (by class)

Class: 5-Hydroxytryptamine (5-HT3) Receptor Antagonists

10335

Ondansetron

10164

Dolasetron

10208

Granisetron

10711

Palonosetron

Antihistamines

10257

Dimenhydrinate

10160

Diphenhydramine

Butyrophenones

10169

Droperidol

10210

Haloperidol

Neurokinin-1 Receptor Agonists

10035

Aprepitant

10719

Fosaprepitant

Phenothiazines

10374

Promethazine

10373

Prochlorperazine

Prokinetic

10297

Metoclopramide

PONV Outcomes MPOG Concept IDs:

50227

GI – Symptoms

50636

Misc - Patient Vomiting

50219

Emesis Occurrence

10503

Emesis

90010

PONV Assessment

90371

Postoperative Nausea and/or Vomiting

90009

PONV Interventions

Measure Start MPOG Concept IDs

50008

AACD Patient Out of Room Date/Time

50010

AACD Recovery Room In Date/Time

50066

Phase I Recovery Room In Date/Time

50068

Phase II Recovery Room In Date/Time

50379

Monitoring - Automated Physiologic Data Capture Stopped

Data Diagnostics Affected
  • Percentage of Cases with Professional Fee Procedure Codes
  • Percentage of Cases with Antiemetic Medications
  • Percentage of Cases in which the Patient has a known Gender
  • Percentage of Intraoperative Notes with a Meaningful Note Mapping
  • Percentage of Preoperative Notes with a Meaningful Type Mapping
Rationale

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 surgery. Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period. The Apfel score is one of the most common risk predictors for PONV and is based on 4 variables: female gender, non-smoking status, history of PONV or motion sickness and postoperative opioid administration. The presence of each additional risk factor increases a patient’s risk of PONV by twenty percent. 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. For the purpose of this measure, PONV is defined as administering any rescue medication (antiemetic MPOG Concepts in table below) or documentation of nausea or vomiting in the immediate postoperative period.

Risk Adjustment

Not applicable

References
  1. Gillmann HJ, Wasilenko S, Zuger J, et al. Standardised electronic algorithms for monitoring prophylaxis of postoperative nausea and vomiting. Archives of medical science : AMS. 2019;15(2):408-415.
  2. Collins AS. Postoperative nausea and vomiting in adults: implications for critical care. Critical care nurse. 2011;31(6):36-45.
  3. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia and analgesia. 2014;118(1):85-113.
  4. Schraag S, Pradelli L, Alsaleh AJO, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC anesthesiology. 2018;18(1):162.
  5. Gan TJ, Ginsberg B, Grant AP, Glass PS. Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology. 1996;85(5):1036-1042.
  6. De Oliveira GS, Jr., Castro-Alves LJ, Chang R, Yaghmour E, McCarthy RJ. Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii's studies. British journal of anaesthesia. 2012;109(5):688-697.
  7. Mascha EJ, Gan TJ, Vetter TR. Quality Improvement Interventions Associated With Improved Postoperative Nausea and Vomiting: Separating the Signal From the Noise. Anesthesia and analgesia. 2019;128(5):847-849.