Measure ID

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

Measure Type
Available for Provider Feedback

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


Pediatric patients ≥ 3 and < 18 years old who have one or more risk factors for PONV:

  • Age < 3 or ≥ 18 years
  • ASA 5 or 6 including Organ Procurement (CPT: 01990)
  • MAC cases (determined by Anesthesia Technique: General value codes: 0,4,5)
  • Patients transferred directly to the ICU
  • Procedure Types:
    • Labor Epidurals (determined by Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)
    • Procedures completed in a room with location tag 'Radiation Oncology'
    • MRI without additional procedures
    • ECT
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).

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)

Long Acting Opioids

  • Any of the following medications administered after Induction End (if not take the earliest of Anesthesia Ready (50018), Surgery Start Date/Time) and before PACU End
    • 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

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

Risk Adjustment

Not applicable

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 Start. If not available then,
  3. Provider signed in at Surgery 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)
MPOG Phenotypes Used
  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
 03/15/2024  Other Measure Build Details  Added considered routes for antiemetic administration