Date of Award

Spring 2021

Project Type

Clinical Doctorate

College or School




Program or Major

Doctor of Nursing Practice

Degree Name


First Advisor

Sue Fetzer

Second Advisor

John McNemar


Postoperative nausea and vomiting (PONV) remains a common complication affecting surgical patients after receiving anesthesia. Prevention of PONV is important in an ambulatory surgical setting where patient access to rescue treatment is limited after discharge. A quality improvement (QI) project introduced a simplified PONV prevention strategy to decrease the incidence of PONV at a Veterans Health Administration ambulatory surgery center. A retrospective chart audit of all facility surgical patients receiving anesthesia care (n = 94), excluding ophthalmology patients, was conducted prior to COVID-19 restrictions to establish baseline PONV incidence. An evidence-based, simplified PONV prevention protocol was developed and implemented. After a 2-week protocol familiarization period an 8-week chart audit of all surgical patients receiving anesthesia care (n = 81) was performed determining post-protocol PONV incidence. The incidence of PONV post-protocol implementation was significantly lower (8.6% vs 19.1%, p < .001). The type of anesthesia administered, monitored anesthesia versus general anesthesia (p = .827), did not influence the incidence of PONV. An unanticipated finding was a significant increase in PACU length of stay between post-protocol and baseline samples (86 minutes vs 71.5 minutes, p = .001). Implementation of a simplified protocol for the prevention of PONV resulted in a significant reduction in PONV incidence.