Measure ID

Percentage of patients 3 through 17 years of age, who receive appropriate antiemetic prophylaxis preoperatively and/or intraoperatively.

Measure Type

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 surgery2. Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period.3 Combination therapy that includes two prophylactic pharmacologic anti-emetic agents of different classes is most effective when managing PONV in children.4,5

A separate PONV risk model should be considered for pediatric patients as many proven risk factors for adults are difficult to assess or do not apply to children.6 The independent PONV risk factors identified for pediatrics include post-pubertal females, positive history of PONV (individual and/or immediate family), at risk surgery (strabismus, adenotonsillectomy, otoplasty), administration of long acting opioids and volatile anesthetic duration greater than 30 minutes.1 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.7,8

Measure Time Period

4 hours before Anesthesia Start to PACU Start


Patients ≥ 3 and < 17 years old who have one or more risk factors for PONV:

  • Patients < 3 or > 17 years old.
  • ASA 5 or 6
  • Labor Epidurals (Value code: 3 and 6)
  • MRI Procedures (Value code: 1)
  • Procedure Type: ECT
  • 'MAC/Sedation' cases as defined by the Anesthesia Technique: General phenotype (Value code: 0,4,5)
  • Patients transferred directly to the ICU
  • Procedures completed in a room with location tag 'Radiation Oncology'
  • Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'
Success Criteria
  • Patients at low risk for PONV (1 Risk Factors) receive at least one prophylactic pharmacologic antiemetic. 


  • Patients at moderate risk for PONV (2 Risk Factors) receive combination therapy consisting of at least two prophylactic pharmacologic antiemetic agents from different classes


  • Patients at high risk for PONV (> 2 Risk Factors) receive three prophylactic pharmacologic antiemetic agents from different classes
Other Measure Details

All patients are assumed to have 1 risk factor based on age inclusion criteria (3-17yo).

Long Acting Opioids

Concept_ID         Opioids

10219                    HYDROMORPHONE

10279                    MEPERIDINE

10290                    METHADONE

10306                    MORPHINE

10341                    OXYCODONE

10481                    OXYCODONE / ACETAMINOPHEN 5 MG / 325 MG

10482                    HYDROCODONE / ACETAMINOPHEN 5 MG / 325 MG

10483                    HYDROCODONE / ACETAMINOPHEN 7.5 MG / 500 MG


Provider Attribution

Provider(s) signed in at Induction End.

Method for determining Responsible Provider:

  1. Provider signed in at Anesthesia Induction End. If not available then,
  2. Provider signed in at Anesthesia Induction Begin. If not available then,
  3. Provider signed in at Procedure Start. If not available then,
  4. Provider signed in at Patient in Room. If not available then,
  5. Provider signed in Anesthesia Start.
MPOG Concept Used

Antiemetic (by class)

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

  • 10335 Ondansetron
  • 10164 Dolasetron
  • 10208 Granisetron
  • 10711 Palonosetron


  • 10400 Scopolamine Patch
  • 10399 Scopolamine
  • 11040 Butylscopolamine


  • 10257 Dimenhydrinate
  • 10160 Diphenhydramine
  • 10635 Meclizine


  • 10169 Droperidol
  • 10210 Haloperidol

Neurokinin-1 Receptor Agonists

  • 10035 Aprepitant
  • 10719 Fosaprepitant


  • 10374 Promethazine
  • 10373 Prochlorperazine


  • 10147 Dexamethasone
  • 10296 Methylprednisolone


  • 10297 Metoclopramide


  • 10377 Propofol (Infusion only)
  1. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-448.
  2. 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.
  3. Collins AS. Postoperative nausea and vomiting in adults: implications for critical care. Critical care nurse. 2011;31(6):36-45.
  4. Shen YD, Chen CY, Wu CH, Cherng YG, Tam KW. Dexamethasone, ondansetron, and their combination and postoperative nausea and vomiting in children undergoing strabismus surgery: a meta-analysis of randomized controlled trials. Paediatric anaesthesia. 2014;24(5):490-498.
  5. Eberhart LH, Geldner G, Kranke P, et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesthesia and analgesia. 2004;99(6):1630-1637, table of contents.
  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. 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.
Measure Authors

 Measure Author


 Meridith Wade, MSN, RN

 University of Michigan

 Rob Coleman

 University of Michigan

 MPOG Pediatric Subcommittee



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


Published Date: 08/2021
 Date  Criteria  Revision
 01/18/2022  Exclusion  Added MAC/Sedation exclusion
 11/11/2021  Exclusion  Added Radiation Oncology room tag exclusion
 09/15/2021  Exclusion  ECT: Modified to use new phenotype