Percentage of patients who had a procedure requiring general anesthesia OR cesarean delivery and received appropriate prophylaxis for postoperative nausea and vomiting.
The purpose of this process of care measure is to reduce the incidence of postoperative nausea and vomiting in adult surgical patients. 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.1 Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period.2-3 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.4-7 In patients undergoing cesarean delivery, the Society for Obstetric Anesthesia and Perinatology recommends the use of at least 2 antiemetic agents from different classes to reduce the incidence of PONV.8
All patients who meet one of the following criteria:
PONV Risk Factors:
For patients ≥18 years old undergoing general anesthesia:
1. At least two prophylactic pharmacologic antiemetic agents of different classes administered preoperatively or intraoperatively for patients with one or two risk factors
2. At least three prophylactic pharmacologic antiemetic agents from different classes preoperatively or intraoperatively for patients with three or more risk factors
For Cesarean Delivery Cases only (with or without general anesthesia, any age):
At least two prophylactic pharmacologic antiemetic agents from different classes preoperatively or intraoperatively.
Note: In addition, propofol infusion is accepted as one of the antiemetic options for this measure. The foregoing list of medications/drug names is based on clinical guidelines and other evidence. The specified drugs were selected based on the strength of evidence for their clinical effectiveness. This list of selected drugs may not be current. Physicians and other healthcare professionals should refer to the FDA’s web site page entitled “Drug Safety Communications” for up-to-date drug recall and alert information when prescribing medications.
Algorithm for Determining Surgery Duration for 30-minute Exclusion:
*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.
Provider(s) signed in at Induction End.
Method for determining Responsible Provider:
Antiemetic (by class)
Class: 5-Hydroxytryptamine (5-HT3) Receptor Antagonists
Neurokinin-1 Receptor Agonists
PONV Risk Factor- Smoking Status
Refer to Tobacco Smoking Classification phenotype for more details.
PONV Risk Factor- History of PONV/Motion Sickness
PONV Risk Factor- Postoperative Opioid
Intravenous or Oral Medications
Local anesthetics with opioids
Kate Buehler, MS, RN
|Univeristy of Michigan|
Nirav Shah, MD
|University of Michigan|
|University of Michigan|
MPOG Quality Committee
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
|10/13/2023||Exclusion||Add CPT: 01990 for Organ Harvest exclusion; Updated bronchoscopy exclusion to reference bronch phenotype; Removed exclusion for MRI; added exclusion for Diagnostic Imaging (value code: 1)|
|04/11/2023||Exclusion||Case duration updated to use Surgery Duration algorithm|
|03/16/2023||Exclusion||Replaced Non-Operative phenotype with Intubation Only as exclusion|