Measure Abbreviation
PONV-04-Peds
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
Process
Description

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

Measure Time Period
Inclusions

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

Exclusions
  • Patients < 3 or > 17 years old.
  • ASA 5 or 6
  • Labor Epidurals (Value code: 3 and 6)
  • Radiology Procedures
  • Patients transferred directly to the ICU
  • Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'
Success
  • 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 Build 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

 

Responsible Provider

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.
Threshold
90%
MPOG Concept IDs Required

Antiemetic MPOG Concept IDs (by class)

10377

Propofol (Infusion only)

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

10335

Ondansetron

10164

Dolasetron

10208

Granisetron

10711

Palonosetron

Anticholinergics

10400

Scopolamine Patch

10399

Scopolamine

11040

Butylscopolamine

Antihistamines

10257

Dimenhydrinate

10160

Diphenhydramine

10635

Meclizine

Butyrophenones

10169

Droperidol

10210

Haloperidol

Neurokinin-1 Receptor Agonists

10035

Aprepitant

10719

Fosaprepitant

Phenothiazines

10374

Promethazine

10373

Prochlorperazine

Steroids

10147

Dexamethasone

10296

Methylprednisolone

Prokinetic

10297

Metoclopramide

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 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

References
  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.