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Nausea and vomiting are frequent side effects impacting comfort and recovery for cardiac surgery patients. Internal evidence from a chart review of cardiac surgery patients determined that 39% of patients received a post-operative antiemetic. Changing the treatment for post-operative nausea and vomiting (PONV) required changes in the physician order set and nurse administration of medications. An interdisciplinary team of nurses, pharmacists, cardiothoracic surgeons, and anesthesiologists searched and critiqued the available empirical evidence, in particular, nationally published consensus guidelines developed in 2003. The guidelines were synthesized in a table outlining strengths, weaknesses, applicability, and feasibility of adoption. Information not covered in the guidelines was addressed separately. Based on this synthesis, an interdisciplinary Evidence Based Protocol for the prevention and treatment of PONV in cardiac surgery patients was developed. At this point, challenges to the project began. Although not new research, this evidence-based quality improvement project did involve collecting demographic data on patients and necessitated meeting all IRB and HIPPA requirements regarding the manner in which patient information is collected. Learning what patient information could and could not be collected without individual informed consent was the first challenge. The logistical challenges of data collection, garnering support of all cardiothoracic surgeons, physician assistants, and anesthesiologists, and review by all appropriate committees and stakeholders were followed by inconsistent interdisciplinary adherence to the protocol. The Clinical Scholar who coordinated this project will speak to the multiple unforeseen issues that arose and how she used available resources to address each challenge of this interdisciplinary evidence-based project, the small steps taken to change the culture.