PONV prophylaxis strategies vary widely, in part because PONV is a complex and sometimes unpredictable event. There are also numerous 'treatment' options, which further complicates decision-making. Still, researchers have produced some solid evidence that can guide practitioners in making sound decisions when it comes to PONV prophylaxis. Essentially, there are three steps to ensuring the most clinically and cost-effective approach: Target at-risk patients, reduce baseline risk and prescribe the most appropriate antiemetic therapy for the clinical need.

Step One:
Target At-Risk Patients
Outpatient practitioners often err on the side of prevention, and for good reason. PONV can cost outpatient facilities in both dollars and patient satisfaction scores. In office surgical suites in particular, where nursing labor costs are not as fixed as they are in the inpatient environment, a prolonged PACU stay can affect the bottom line. Still, research clearly shows that an "across-the-board" approach to PONV prevention results in overprescribing of prophylactic antiemetics - a practice that is neither clinically nor cost-effective. Antiemetics can cause side effects that hinder recovery.