Henry Ford West Bloomfield Hospital
PONV 05
Best Practice
Advisory
• Release of 3 BPAs in EPIC for PONV
reminders
• Released in May 2022
• BPA 1 is for patients with 0-2 risk factors
• BPA 2 for patients with 3 or more risks
• BPA 3 is for cesarean sections
BPA- Patients
with 1-2 Risk
factors for
PONV
BPA- Patients
with 3 or more
Risk factors for
PONV
BPA- Cesarean
Sections for
PONV
PONV Education
PONV Risk Factors
0-2 Risk Factors
3 or >
Female Age <50
History of PONV
Use of inhalation agent >1 hr
History of motion sickness Laparoscopic surgery
Non Smoker GYN surgery
Use of opioids intraop
Give 3 or more antiemetics from different classes
Risk Factors include:
Give Preop or Intraop
Give 2 Antiemetics from different classes
Scopolamine Patch
1.5 mg transdermal behind ear
$21.30
Meclizine 25 PO
$0.32
Dimenhydrinate 50 mg PO
$0.15
Aprepitant 40 gm PO (3hrs prior to induction)
$87.95
Dexamethasone 4 mg IV
$2.63
Ondansetron 4 mg IV
$0.33
Ondansetron 4 mg IV
$0.33
Haloperidol 0.5 mg IV
$0.06
Prochlorperazine 5 mg IV
$1.84
Diphenhydramine 12.5 mg IV
$0.14
Dexamethasone
4 mg IV
$2.63
Metoclopramide
20 mg IV
$1.70
Promethazine 6.25 mg PO
$0.08
At Induction
Steroids
HFHS ADULT Antiemetics Prophylaxis
PREOPERATIVE
Anticholinergics
Antihistamines
Neurokinin-1 Receptor Agonists
End of Case Prior to
Emergence
Class: 5-Hydroxytryptamine (5-HT3) Receptor Antagonists
PACU or up to 6
hours after Surgery
Class: 5-Hydroxytryptamine (5-HT3) Receptor Antagonists
Butyrophenones
Phenothiazines
Antihistamines
Steroids
Other Antiemetics
Prokinetic
Phenothiazines
Try to avoid patient having PONV in recovery up to 6 hours after surgery
Educational
page 1 of 2-
page Flyer
Educational
page 2 of 2-
page Flyer
How We
Educate
EPIC change newsletter with BPAs
listed
Monthly System Newsletter with
PONV as focus
Educational flyer distribution
Provider Meeting reminders and
education
Future Process Improvement
• Standardizing anesthesia medication carts across the system
• Include several antiemetic medications in the updated drawer layout
• We have added Haldol which currently has to be retrieved from the
Pyxis
