MPOG Pediatric
Subcommittee Meeting
February 17, 2021
Agenda
5 minutes
Announcements
5 minutes
Multimodal Analgesia (PAIN-01)
10 minutes
MPOG Pediatrics: 2021 Plans
40 minutes
PONV Prophylaxis (PONV-02)
Measure Review and Discussion
2021 MPOG Meetings
• Pediatric Subcommittee Meetings
- February 17
- May 19
- August 18
- December 15
• MPOG Annual Retreat 2021
- October 8 (San Diego, CA)
2020 Recap
• Pediatric Measure Build x4
– Intraoperative Hypothermia (TEMP-04)
– OME (T&A and Spine)
– Multimodal Analgesia (PAIN-01)
• 150,000+ pediatric cases submitted to MPOG central
database
• Pediatric QI Dashboard Released
MPOG Peds Membership
ACTIVE - (Preop → PACU data)
1. Vanderbilt (Monroe Carell Jr. Children’s)
2. Michigan Medicine (C.S. Mott Children’s)
3. Washington University (St. Louis Children’s)
4. Oregon Health & Science University (Doernbecher Children’s)
5. Yale University (Yale-New Haven Children’s)
6. University of California San Francisco (Benioff Children’s)
7. Duke Children’s Hospital
8. NYU-Langone (Hassenfeld Children’s Hospital)
9. Massachusetts General (MassGeneral Hospital for Children)
10. MD Anderson (Children’s Cancer Hospital)
11. University of Chicago Medicine (Comer Children’s)
12. Dartmouth (Children’s Hospital at Dartmouth-Hitchcock)
13. University of Virginia Children’s Hospital
14. Beaumont Health (Beaumont Children’s)
15. Bronson Healthcare Group
ACTIVE - (Intraop data Only)
● Oklahoma University
● 2021 Conversions
○ Weill Cornell University
○ Cleveland Clinic Children’s
○ Wake Forest
○ Memorial Sloan Kettering Cancer Center
New Sites Onboarding
● Spectrum Health (Helen-Devos Children’s)
● Penn State Health
● Boston Children’s
● Lucile Packard Children’s - application submitted!
PAIN 01 (Peds)
Multimodal Analgesia
New Measure
Description
• Percentage of patients < 18 years old who undergo a surgical or
therapeutic procedure and receive a non-opioid adjunct preoperatively
or intraoperatively
Success
• At least one non-opioid adjunct (medication, regional block, caudal, or
epidural) was administered to the patient during the preoperative or
intraoperative period.
Exclusions
• ASA 5 and 6
• Cardiac Surgery, Obstetric Procedures, Radiology Procedures, ABR
testing, and other non-operative procedures
PAIN-01 Performance across MPOG pediatric sites (2020)
2021 Measure Survey
15 responses - Thank You!
2021 Measure Survey Results
60% Extremely Important
33% Very Important
33% Moderately Important
20% Not Important
33% Extremely Important
2021 Measure Survey Results - ‘Write Ins’
Suggestion Rating Related MPOG Measures
Temperature Regulation in Infants, Hypothermia (postop) Extremely important TEMP 03, TEMP 04
Appropriate monitoring (i.e. documented TOF) and use of any
(sugammadex or neostigmine) for reversal)
Extremely important NMB 01, NMB 02
Postoperative Nausea & Vomiting Very important PONV 02, PONV 03
Blood product usage - PRBC and other, blood conservation Very important TRAN 02
Use of appropriate handover tools, # of handovers intraop, etc. Very important TOC 01, TOC 02, TOC 03
Use of PEEP for all cases when using PPV. Very important PUL 03
Hypoglycemia and hyperglycemia prevalence across pediatric
surgical patients
Moderately important GLU 01 - 05
Link to All MPOG Measures
Discussion
Do any of these line up with recent, current, or
upcoming QI projects in your department?
2021 Plans
Pediatric Subcommittee Goals - 2021
#1 Review and Modify existing MPOG Measures
• Quality measures should reflect the latest evidence in pediatrics or may
be“topped out” and worth retiring if no longer relevant for QI
Pediatric Subcommittee Goals - 2021
#2 Add OME dashboard to new reporting tool
#3 Feature presentations on how sites have
used pediatric data to do QI or research to
spark ideas of new MPOG projects
#4 Have two additional MPOG sites merge
NSQIP-peds data
Measure Review
PONV Prophylaxis in Children (PONV-02)
PONV 02 - Released March, 2018
Description
• Percentage of pediatric patients 3 - 17yo with ≥ two risk factors for
postoperative vomiting (POV), and receive antiemetic combination
therapy.
Success
• Patient receives at least two prophylactic pharmacologic antiemetic
agents of different classes preoperatively or intraoperatively
Attribution: Provider(s) signed in at Induction End. If not available then,
1. Induction Begin
2. Procedure Start
3. Patient in Room
4. Anesthesia Start
PONV 02 - Current Specification
Inclusion Criteria
• Patients ages 3-17 years old
• Received an inhalational
general anesthetic
• Has ≥ 2 risk factors for POV
– History of PONV
– Strabismus surgery
– Surgery ≥ 30 minutes
Exclusion Criteria
• Patients < 3 or > 17 years old.
• Patients transferred directly → ICU
• Liver Transplants
• Lung Transplants
• Procedures on the Neck
• Intrathoracic Procedures
• Procedures on the Lower Abdomen
• Obstetric Procedures & Labor
Epidurals
• Endoscopy
• Obturator neurectomy
• Shoulder cast application
PONV Prophylaxis vs. Outcomes
A Single Center QI Report….
PONV Prophylaxis Compliance
Antiemetic prophylaxis compliance and PONV outcomes were analyzed for 22,121 pediatric
patients from 2017 to 2020. Baseline compliance of PONV-02 was 76%. Following release of
the PONV 02 quality measure in March 2018, rates of PONV-02 compliance steadily increased
to 84% by December 2019.
PONV-02 Measure Released, March 2018
PONV Outcomes
Baseline rate of PONV outcomes was 6.5% in January 2017. Despite an increase in
prophylactic compliance, the average percentage of patients who reported nausea or
vomiting in the recovery room remained at 6%. There was a slight decrease in the
percentage of patients who received a rescue antiemetic after surgery (1.6%)
Similar outcomes in 2020...
Where do we go from here...
Proposed Risk Factors
• Post-pubertal females
• Exposure to Volatile Anesthetics
• Hx of PONV (personal or first-degree
relative)
• At Risk Surgery
– Strabismus
– Adenotonsillectomy
– Tympanoplasty/Otoplasty
• Anesthetic Duration ≥ 30 minutes
• Postoperative Long-acting opioids
– Administered after Intubation
Defined as age 12y
Include Nitrous
Denominator
Inclusion Criteria
• Patients 3 - 17 yo
• Has ≥ ___Risk Factors for PONV
Exclusion Criteria
• Patients <3 or >17 yo
• ASA 5 or 6
• Labor Epidural Cases
• Direct ICU Transport
Exclude all patients who remained intubated?
Antiemetics Considered
Total threshold vs.
infusion only?
PONV Prophylaxis Measure - Next Steps
• We will incorporate your feedback and draft a
measure specification
• Build and validate
• Present the new PONV-02 specification at the next
Quality Committee meeting on March 22nd
Thank you
