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  • Measure Summary
  • NQMC:010655
  • Oct 2015

Perioperative care: percentage of patients, aged 3 through 17 years of age, who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for postoperative vomiting (POV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively or intraoperatively.

American Society of Anesthesiologists (ASA). Prevention of post-operative vomiting (POV) - combination therapy for pediatric patients at high risk for POV. Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

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Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients, aged 3 through 17 years of age, who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for postoperative vomiting (POV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively or intraoperatively.

Rationale

Postoperative nausea and vomiting (PONV) is an important patient-centered outcome of anesthesia care. PONV is highly dissatisfying to patients, although rarely life-threatening. A large body of scientific literature has defined risk factors for PONV; demonstrated effective prophylactic regimes based on these risk factors; and demonstrated high variability in this outcome across individual centers and providers (Kranke & Eberhart, 2011; Singla et al., 2010). Further, a number of papers have shown that performance can be assessed at the level of individual providers — the outcome is common enough that sufficient power exists to assess variability and improvement at this level (Dzwonczyk et al., 2012). A separate measure is needed for pediatric patients because the risk factors and recommended prophylaxis are different from adults.

Clinical Recommendation Statements:

The following evidence statements are quoted verbatim from the referenced clinical guidelines: Society for Ambulatory Anesthesia (SAMBA) recommendations:

Administer prophylactic antiemetic therapy to children at increased risk for post-operative vomiting (POV); as in adults, use of combination therapy is most effective (Gan et al., 2014).

All prophylaxis in children at moderate or high risk for POV should include combination therapy using a 5-hydroxytryptamine (5-HT3) antagonist and a second drug. Because the effects of interventions from different drug classes are additive, combining interventions has an additive effect in risk reduction (Gan et al., 2014).

Evidence for Rationale

American Society of Anesthesiologists (ASA). Prevention of post-operative vomiting (POV) - combination therapy for pediatric patients at high risk for POV. Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

Dzwonczyk R, Weaver TE, Puente EG, Bergese SD. Postoperative nausea and vomiting prophylaxis from an economic point of view. Am J Ther. 2012 Jan;19(1):11-5. PubMed External Web Site Policy

Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, Watcha M, Chung F, Angus S, Apfel CC, Bergese SD, Candiotti KA, Chan MT, Davis PJ, Hooper VD, Lagoo-Deenadayalan S, Myles P, Nezat G, Philip BK, Tramèr MR, Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014 Jan;118(1):85-113. PubMed External Web Site Policy

Kranke P, Eberhart LH. Possibilities and limitations in the pharmacological management of postoperative nausea and vomiting. Eur J Anaesthesiol. 2011 Nov;28(11):758-65. PubMed External Web Site Policy

Singla NK, Singla SK, Chung F, Kutsogiannis DJ, Blackburn L, Lane SR, Levin J, Johnson B, Pergolizzi JV Jr. Phase II study to evaluate the safety and efficacy of the oral neurokinin-1 receptor antagonist casopitant (GW679769) administered with ondansetron for the prevention of postoperative and postdischarge nausea and vomiting in high-risk patients. Anesthesiology. 2010;113(1):74-82. PubMed External Web Site Policy

Primary Health Components

Perioperative care; general anesthesia; inhalational anesthetic; postoperative vomiting (POV); prophylaxis; pharmacologic anti-emetic agent; children; adolescents

Denominator Description

All patients, aged 3 through 17 years of age, who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for postoperative vomiting (POV) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively or intraoperatively (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory Procedure/Imaging Center

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age 3 to 17 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients, aged 3 through 17 years of age, who undergo a procedure* under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for postoperative vomiting (POV)

Note: Risk factors for POV are:

  • Surgery greater than or equal to 30 minutes
  • Age greater than or equal to 3 years
  • Strabismus surgery
  • History of POV or postoperative nausea and vomiting (PONV) in parent or sibling

*Any procedure including surgical, therapeutic or diagnostic.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Patients who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively or intraoperatively

Note:

  • The recommended pharmacologic anti-emetics for postoperative vomiting (POV) prophylaxis in pediatric patients at risk of POV include (but may not be limited to):
    • 5-hydroxytryptamine (5-HT3) receptor antagonists (recommended as the first choice for prophylaxis for POV in children)
    • Dexamethasone
    • Antihistamines
    • Butyrophenones
  • 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 health care professionals should refer to the U.S. Food and Drug Administration (FDA)'s Web site page entitled "Drug Safety Communications" for up-to-date drug recall and alert information when prescribing medications. 

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Prevention of post-operative vomiting (POV) – combination therapy for pediatric patients at high risk for POV.

Measure Collection Name

Perioperative Care

Submitter

American Society of Anesthesiologists - Medical Specialty Society

Developer

American Society of Anesthesiologists - Medical Specialty Society

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Work Group Members

Alexander A. Hannenberg, MD (Co-chair); Andrew J. Patterson, MD, PhD (Co-chair); William R. Andrews, MD, MS; Rebecca A. Aslakson, MD, PhD; Daniel R. Brown, MD, PhD; Neal H. Cohen, MD, MPH, MS; Peggy Duke, MD; Heidi L. Frankel, MD; Lorraine M. Jordan, BSN, MS, PhD; Jeremy M. Kahn, MD, MS; Jason N. Katz, MD, MHS; Gerald A. Maccioli, MD; Catherine L. Scholl, MD; Todd L. Slesinger, MD; Victoria M. Steelman, PhD, RN; Avery Tung, MD

Work Group Staff

Meredith Herzog, American Board of Medical Specialties; Maureen Amos, American Society of Anesthesiologists; Mark Antman, DDS, MBA, American Medical Association; Elvia Chavarria, MPH, American Medical Association; Jodie Dvorkin, MD, MPH, American Medical Association; Kendra Hanley, MS, American Medical Association; Jennifer Heffernan, MPH, American Medical Association; Toni Kaye, MPH, American Medical Association; Kimberly Smuk, RHIA, American Medical Association; Elvira L. Ryan, MBA, BSN, RN, The Joint Commission

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

Annually

Date of Next Anticipated Revision

2016 Nov

Measure Status

This is the current release of the measure.

Source(s)

American Society of Anesthesiologists (ASA). Prevention of post-operative vomiting (POV) - combination therapy for pediatric patients at high risk for POV. Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

Measure Availability

Source available from the American Society of Anesthesiologists (ASA) Web site External Web Site Policy.

For more information, contact ASA at 1061 American Lane Schaumburg, IL 60173-4973; Phone: 847-825-5586; Fax: 847-825-1692; E-mail: info@asahq.org; Web site: asahq.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on March 23, 2016. The information was verified by the measure developer on April 26, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, please contact the American Society of Anesthesiologists (ASA) for downloading, use and reproduction at (847) 825-5589 or (202) 289-2222.

The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.

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Commercial uses of the Measures require a license agreement between the user and the American Medical Association (AMA), [on behalf of the Physician Consortium for Performance Improvement® (PCPI®)] or American Society of Anesthesiologists (ASA). Neither the AMA, ASA, PCPI, nor its members shall be responsible for any use of the Measures.

The AMA's, PCPI's and National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. ASA is solely responsible for the review and enhancement ("Maintenance") of the Measures as of May 23, 2014. ASA encourages use of the Measures by other health care professionals, where appropriate.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

© 2014 American Medical Association and American Society of Anesthesiologists. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ASA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

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