Adult PONV/PDNV Policy

Adult Post-Operative/Post-Discharge Nausea and Vomiting (PONV/PDNV) Policy

Prepared by:_____________________ Authorized by:____________________________

Effective Date:_________________________

This policy will explain the procedure for assessing the degree of risk for PONV in adult patients (>15yrs)
preoperatively. It addresses the perioperative drug therapy these patients may receive depending on their risk
level and explains the documentation required. The intent of this policy is to meet the Society for Ambulatory
Anesthesia (SAMBA) Guidelines for the Management of PONV with the goal of optimizing patient outcomes and
value for PONV.

Guideline 1: Identify Patients' Risk for PONV

Guideline 2: Reduce Baseline Risk Factors for PONV

Guideline 3: Administer PONV Prophylaxis Using One to Two Interventions in Adults at Moderate Risk for
PONV

Guideline 4: Administer Prophylactic Therapy with Combination (>2) Interventions/Multimodal Therapy in
Patients at High Risk for PONV

Guideline 5: Administer Prophylactic Antiemetic Therapy to Children at Increased Risk for PONV; as in
Adults, Use of Combination Therapy Is Most Effective). Currently follow anesthesiologist's individual
orders for pediatric patients.

Guideline 6: Provide Antiemetic Treatment to Patients with PONV Who Did Not Receive Prophylaxis or in
Whom Prophylaxis Failed

1. Identification and Assessment of Patients' Risk for PONV
Screening for preoperative assessment of PONV risk (a section of the Pre-operative Record) is completed by the
nursing staff at the time of the preadmission phone call or upon admission on the day of surgery.
Risk factors will be assessed and checked as they apply
1. Female
2. Non-smoker
3. History of Motion Sickness OR History of PONV
4. Expected post operative opioid use
Patient risk and risk tolerance will be stratified by the anesthesiologist depending on the number of risk factors
present and relative tolerance for risk of PONV.
1. Low risk (<10%): 0 factors
2. Moderate risk (10-40%): 1-2 factors
3. High risk (>40%): 3-4 factors
(This is a lower risk tolerance than defined in the SAMBA Guidelines)

2. Reduction of Baseline Risk Factors and Prophylaxis for PONV
Anesthesiologist will determine methods to reduce baseline risk (see flow chart below)
PONV prophylaxis will be managed by the anesthesiologist and recorded on the Anesthesia Record.

3. Rescue Antiemetic Treatment For Post-op Patients with PONV
If "PONV Protocol" is checked, signed and dated by the anesthesiologist in the Pre & Post-anesthesia orders
follow the PONV Rescue Protocol for management. If these orders are signed, the RN may write an MD order for
the next dose "per protocol".
Documentation of the medications given will be recorded on the PACU/Phase II Recovery record.
4. Antiemetic Doses (adult) and Timing of Drugs Available at ASC Durango:
Dexamethasone 4-8mg IV at induction
Ondansetron 4mg IV before the end of surgery
Promethazine 2.5-6.25 mg IV at induction (must be diluted to 2.5mg/ml and injected only in a free-flowing IV)
Droperidol 0.625mg IV (2hrs of ECG monitoring required after administration)
Scopolamine patch 1.5 mg on admission
Dimenhydrinate (Dramamine) 12.5-25 mg or 1mg/kg IV timing not well defined (alternative treatment to
promethazine in PONV Rescue Protocol)
Diphenhydramine (Benadryl) 12.5-25 mg IV q6h prn (use if patient has an allergy to dimenhydrinate)