Identified a practice problem, searched for evidence, critically appraised and synthesis evidence. Assessed feasibility and determination of fit in protocol development led to a two prong approach in reducing postoperative nausea and vomiting (PONV) (preoperative risk assessment and targeted prophylaxis) in the post anesthesia care unit (PACU). I was able to build support for protocol implementation throughout the health system by piloting the protocol for 1,139 patients, demonstrating a reduction in PONV from nearly 54% to less than 13%. Currently working on TIVA-ERAS, ESPB and PECS implementation.