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.

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.

PACU Start through 6 hours after Anesthesia End

• All patients, regardless of age, who undergo any procedure including surgical, therapeutic, or diagnostic requiring care by anesthesia providers.
• C-section cases (as determined by the MPOG 'Obstetric Anesthesia Type' Phenotype results 'cesarean section' , 'cesarean hysterectomy' and 'Conversion (cesarean delivery portion)')

• Patients transferred directly to the ICU
• Organ Harvest (CPT: 01990)
• Liver Transplants 
• Lung Transplants 
• Obstetric Non-Operative Procedures (CPT: 01958)
• Labor Epidurals (as determined by the MPOG 'Obstetric Anesthesia Type' Phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)')
• Procedures completed in a room with location tag 'Radiation Oncology'
• Invalid cases where Measure End results prior to Measure Start

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

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 Start. 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

Not applicable

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

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