Measure ID
PONV-03
Domain
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 Type
Outcome
Available for Provider Feedback
Yes
Threshold
<10%
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.

Measure Time Period

PACU Start to 6 hours after Anesthesia End

Inclusions

All patients requiring anesthesia.

Exclusions
  • ASA 6 including Organ Procurement
  • Patients transferred directly to the ICU
  • Procedures:
  • Procedures completed in a room with location tag 'Radiation Oncology'
Success Criteria

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

Other Measure Details
  • Only antiemetics given via the following routes will be considered:
    • 2001 IV
    • 2003 Intramuscular
    • 2008 Oral
    • 2011 Sublingual
    • 2012 Rectal
    • 2022 Intraosseous
    • 2023 Enteric Tube
    • 2997 Other - Not Listed
    • 2998 Other - Not Specified
    • 2999 Other
    • For scopolamine only: Topical (2013) or Transdermal (2027)
  • Antiemetics documented in mL (ID: 1025) will be excluded.
  • Antiemetic infusions (ml/hr) initiated intraop and continuing postoperatively will be excluded. However, antiemetic infusions initiated after anesthesia end will be considered. (Route Concept ID: 1100)

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Risk Adjustment

Pending

Provider Attribution

For cases > 60 minutes: Provider(s) for a given case who are signed in ≥ 40 minutes.

For cases ≤ 60 minutes: Provider(s) are attributed.

Algorithm for determining Case Duration:

MPOG Concept Used

Antiemetic

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

Benzamides

  • 10820 Amisulpride

Neurokinin-1 Receptor Agonists

  • 10035 Aprepitant
  • 10719 Fosaprepitant

Phenothiazines

  • 10374 Promethazine
  • 10373 Prochlorperazine

Prokinetic

  • 10297 Metoclopramide

PONV Outcomes

  • 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

  • 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
MPOG Phenotypes Used
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.
Measure Authors

 Measure Author

 Instiution

 Kate Buehler, MS, RN

 University of Michigan

 Meridith Wade, MSN, RN

 University of Michigan

 Nirav Shah, MD

 University of Michigan

 Rob Coleman

 University of Michigan

 MPOG Quality Committee

 

 

Measure Reviewer(s)
Next Review: 2025
 Date Reviewed  Reviewer  Institution  Summary  QC Vote

 9/26/2022

 Patricia Mack

 Weill Cornell Medical Center

 Review

 Modify

Version
Published Date: 10/2019
Date Criteria Revision
 04/11/2023  Provider  Case duration algorithm updated to remove Case Start/End phenotypes
 07/26/2022  Success  Added Amisulpride as antiemetic
 11/11/2021  Exclusion  Added Radiation Oncology room tag as exclusion
 03/25/2021  Multiple  Modified Measure End, PACU Start; Labor Epidural exclusion now uses Obstetric phenotype
 08/04/2020  Success  Modified to use note entered time if observed time is not available
 01/13/2020  Success  Modified to use Antiemetic Class phenotype to determine medications used
 12/09/2019  Success  Removed Methylprednisolone from list of medications
 11/22/2019  Exclusion  Cases converted to c-section now override labor epidural exclusion
 11/11/2019  Success  Removed Dexamethasone from list of medications
2/22/2024  Multiple  Removed mL/hr units and Route specifications