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PPAI: Postoperative Nausea and Vomiting in the Pediatric Population—A 3-stage performance improvement activity

Purchase Course & Materials

Course Fee
Member price: $220.00
Non-member price: $290.00

Course Description

THIS IS AN ONLINE ACTIVITY. Hard copies are not available.

Member price: $220.00, Non-member price: $290.00 

If you are interested in enrolling as a group for this topic, please send your request to educationcenter@asahq.org. Learn more.


The American Board of Anesthesiology’s (ABA’s) Maintenance of Certification in Anesthesiology Program (MOCA®) Part 4 is titled Practice Performance Assessment and Improvement (PPAI).

Statement of Need.  Postoperative nausea and vomiting (PONV) is a leading cause of patient and/or parental dissatisfaction and leads to increased health care costs due to prolonged postanesthesia care unit (PACU) stays and unanticipated hospital admissions. Surgical concerns include disruption of anastomoses, bleeding, and wound dehiscence. However, universal antiemetic prophylaxis is not cost effective and places patients who are not at risk for PONV at risk for adverse drug effects. Therefore, the anesthesiologist needs to be able to identify those pediatric patients who are at increased risk for PONV in order to formulate an anesthetic plan to mitigate this risk.

One PPAI activity is a case evaluation based performance improvement activity. A case evaluation requires the collection of data from clinical outcomes or patient feedback, comparison to evidence-based practice guidelines, an educational activity, the design and implementation of a plan to improve outcomes, and assessment of the success of the interventions. All of these steps are facilitated by the electronic format of this ASA PPAI program.

NOTE: Care should be taken in selecting the appropriate PPAI topic.

There is a minimum 60-day wait period after creating your performance improvement plan (Stage 2), to implement the plan and collect 10 new cases. Please account for this 60-day wait period requirement to ensure your MOCA diplomate deadline is met.

You will be required to provide actual data from the charts of at least 20 patients that meet all of the following:

  • Between 1 and 16 years old 
  • Surgery lasting longer than 30 minutes 
  • Underwent one of the following surgeries: strabismus repair, adenotonsillectomy, inguinal herniorrhaphy, orchiopexy, penile surgery, middle ear surgery

Please be sure to select a topic that is relevant to your practice.

View course FAQs (PDF)

*ABA diplomates enrolled in MOCA

  • MUST have their ABA ID number on file with ASA. See Update Profile Tutorial for directions on adding/verifying your ABA ID number on your Education Center profile.
  • MUST claim the maximum number of credits at each stage (for a total of 20 continuing medical education [CME] credits) to fulfill MOCA® requirement for PPAI.

This PPAI course fulfills the Case Evaluation requirement of Part 4 of the Maintenance of Certification in Anesthesiology Program (MOCA®) of The American Board of Anesthesiology (ABA). Please consult the ABA website, www.theABA.org, for a list of all MOCA® requirements.

Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®.

Learning Objectives:

Program Goals
The objectives of an improvement module are to:
• provide criteria to facilitate assessment of your current medical management
• support practice improvement by comparing personal practice with current literature recommendations

At the completion of this activity, the learner will be able to:
• identify patients at increased risk of developing PONV
• utilize a multimodal approach to mitigate the risk of PONV
• manage patients in the PACU requiring rescue antiemetic measures.


Included activities:

Faculty & Credentials:

Disclosure Policy
The American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.

Name of individual Individual’s role in activity Relationship(s) with commercial interest(s) disclosed Nature of
Dr. Leslie Jameson Editor-in-Chief Masimo Advisory Board
GE Medical International
Dr. Francine Yudkowitz PPAI Board Member None N/A
Dr. Jaime Hyman PPAI Board Member None N/A
Gary Courington Staff, Course developer None N/A
Dr. Mohammed, Minhaj PPAI Board Member None N/A
Dr. Dawn Dillman PPAI Board Member None N/A
Dr. Kevin W. Hatton PPAI Board Member None N/A

The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient's medical condition.

Core Competencies:

Quality improvement

Target Audience:

ABA diplomates enrolled in MOCA or any anesthesiologist interested in performance improvement.

CME Credit:

20.00 AMA PRA Category 1 Credit™

The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Society of Anesthesiologists designates this PI CME activity for a maximum of 20.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

20.00 Non-physician Credit

Non-physicians may receive a Certificate of Completion stating that this activity was designated for 20.00 AMA PRA Category 1 Credit(s)™.


Participants must complete the online modules, two chart audits, the required readings, an action plan and an evaluation.

Required Hardware / Software:

This program uses the following Web-based technologies: Flash, JavaScript, AJAX, and pop‐up windows. Subscribers need to be sure to set their browsers to allow these technologies to function on their computers before using this program. This program was tested using the following browsers: Internet Explorer 8–9 and Firefox 3.x on Windows platforms, and Firefox 3.x and Safari 3.x–5.x on Macintosh platforms. Performance on other browsers and/or platforms may vary. Adobe Reader is also required. NOTE: This program is NOT supported on iPad.

Activity Release Date:

04/15/2013 (All day)

Activity Expiration Date:

04/14/2016 (All day)

Estimated Time to Complete:

There is a minimum 60-day wait period after creating your performance improvement plan (Stage 2), to implement the plan and collect 10 new cases. Please account for this 60-day wait period requirement to ensure your MOCA diplomate deadline is met.