This is a quality improvement (QI) project that examines post-op nausea and vomiting prophylaxis (PONV) and PONV in the Post Anesthesia Care Unit (PACU) in an Urban Hospital system. The clinical question for this QI project is: In the population of Gynecological (GYN), Urological, and Ear, Nose, and Throat (ENT) surgical patients 18 years and older, how does patient, anesthetic, and surgical risk factors for PONV and the delivery of antiemetics affect the incidence of PONV in the Urban setting?The purpose of this project was to compare anesthetic, surgical, and patient risk factors with the number of antiemetics given, in order to determine anesthesia providers compliance with the Fourth Consensus Guidelines. Data related to patient, anesthetic, and surgical risk factors, and PONV in the PACU was collected via chart review. Data analyses were conducted to determine patient, anesthetic, and surgical risk factors, and PONV prophylaxis administration. The Apfel score was not significantly associated with actual antiemetics. There was also no significant association between patient, anesthesia, and surgical risk factors and the risk for PONV. The percent of PONV at the Urban facility was 14.29%. Overall, 42.9% of patients did not receive the correct number of antiemetics. Education to improve the knowledge gap between understanding of the Fourth Consensus Guidelines and the application of its antiemetic interventions into practice is recommended to improve adherence to guidelines. Keywords: PONV, gynecologic, ENT, Urologic, surgery, urban, anesthesia