Problem: In the 28-bed Cardiac Surgery Intensive Care Unit (CSICU) at an academic medical center, underutilization of antiemetics has resulted in 10% of cardiac surgery patients experiencing postoperative nausea and vomiting (PONV) in early 2023. PONV is linked to complications such as prolonged hospitalization, aspiration, reintubation, and sternal wound dehiscence. Risk factors for PONV include female sex, non-smoking status, history of PONV/motion sickness, and opioid use. Purpose: This project aimed to use the Apfel scale, a validated tool, to guide prophylactic management among cardiac surgery patients and prevent PONV and associated complications. Methods: The Apfel scale was integrated into the electronic health record (EHR). Education sessions were conducted during the first week. The anesthesia team and CSICU staff assessed eligible patients using the Apfel scale and documented it in the EHR. Bedside nurses administered prophylactic antiemetics based on Apfel scores and documented PONV incidences in the EHR. Data was collected through weekly chart audits and evaluated using run charts. Results: During the 14-week implementation period, there was 31% (N=114) adherence to using the Apfel scale, with 26% of patients experiencing PONV within the first 48 postoperative hours. Notably, patients who experienced PONV were not screened using the Apfel scale and did not receive prophylactic antiemetics. Conclusion: The low PONV incidence rate in the screened population aligns with evidence-based literature, emphasizing the Apfel scale's value in risk stratification and reducing PONV incidences and complications. Similarly, integrating the Apfel scale into the EHR improved adherence, highlighting the value of integrating tools into clinical workflows. However, low adherence to the Apfel scale screening suggests the need for additional strategies to improve utilization of the Apfel scale to reduce PONV incidences.