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An interdisciplinary team of physicians and nurses reviewed the internal evidence suggesting that post-operative nausea and vomiting (PONV) is a frequent unwanted sequellae in our ambulatory surgery center. A review of the external evidence suggested that antiemetics are most effective when given prophylactically, with 22-35 % of patient not receiving antiemetics pre-operatively experiencing PONV. However, studies have shown that antiemetics should not be routinely given to all surgical patients. Even when PONV is predictable, prevention is sometimes difficult with a wide range of stimuli provoking the emetic response and no one medication effectively blocks all of the receptors. A combination of medications with different mechanisms of action have been shown to be more effective than the use of a single antiemetic; although the mechanism is unknown, Dexamethasone is synergistic with other antiemetics. Since the treatment of PONV in the unit varied with individual anesthesiologist orders and preferences of the nurses for administration, it was determined that a study to compare the most common treatment methods was warranted. The randomized, double-blinded study is designed to compare the effectiveness of two routine treatments: intravenous Ondansetron and Dexamethasone with Promethazine and Dexamethasone for the prevention of PONV in ambulatory surgery patients undergoing laparoscopic procedures. The cost savings can be significant if Promethazine is shown to be equally or more effective than Ondansetron as a prophylactic antiemetic. A Clinical Scholar is the Primary Investigator. Anesthesiologists will administer Dexamethasone intraoperatively to all study participants. Planning the study progressed smoothly with interdisciplinary participation and support. Yet, the nurse primary investigator encountered many logistical, interdisciplinary challenges as the study progressed. Resolution of these challenges through creative use of resources will be described. By Congress, some preliminary data should be available for discussion.