Antiemetic prescribing practices using a computerized physician order entry system

Abstract

Purpose Adherence to guideline-consistent chemotherapy-induced nausea and vomiting (CINV) prophylaxis is suboptimal. The primary aim of this study was to evaluate the magnitude of compliance to institutional guideline-directed antiemetic prophylaxis using a computerized physician order entry system at a single tertiary care institution. A nurse survey was also performed to evaluate how oncology practices, within a cooperative group, managed clinician orders for the prevention of CINV. Methods The electronic medical records of 100 consecutive patients were evaluated. The primary endpoint was the incidence of compliance to provide all aspects of scheduled institutional guideline-directed antiemetic prophylaxis for acute (day 1) and delayed (days 2–4) CINV. A descriptive analysis was performed on the convenience sample. Logistic regression was completed to determine the predictors of noncompliance. Results The incidence of compliance on days 1–4 was 94 %. Half of the noncompliant events (three of six, 50 %) occurred on day 1 alone and involved patients receiving low-emetogenic chemotherapy. There was a high degree of compliance to institutional guidelines for the treatment of delayed CINV (97 %). Patients receiving minimally emetogenic and moderately emetogenic chemotherapy (N =70) were observed to be 100 % compliant. Patients receiving doxorubicin/cyclophosphamide were numerically less likely to receive institutional guidelines, compared to patients receiving other chemotherapy regimens (OR, 0.24 (0.04, 1.36), p value, 0.05). The nurse survey suggested significant variability amongst the involved institutions with regards to antiemetic prescribing practices. Conclusions Computerized physician order entry is associated with impressive adherence to clinician-prescribing practices, according to institutional guidelines, for acute and delayed CINV.

Perfil Dos Pacientes Oncológicos Atendidos Em Uma Unidade De Emergência

“…Em estudo realizado avaliando os prontuários de 100 pacientes oncológicos identificou que 94% receberam profilaxia antiemética do primeiro ao quarto dia de tratamento com redução expressiva dos sintomas (10).…”

Default Options: Opportunities to Improve Quality and Value in Oncology

“…In a well-publicized example, a cancer center assessed two angiogenesis inhibitors used to treat colorectal cancer. 36,37,55 In the radiotherapy realm, prescriptions specify both the total dose and the fractionation (ie, number of treatments). The hospital therefore declined to carry the more expensive medication on its formulary.…”

Ten-Year Trends in Antiemetic Prescribing in Patients Receiving Highly Emetogenic Chemotherapy

“…27,[29][30][31] In one trial, the use of computerized physician order entry for antiemetics resulted in a 97% rate of compliance with guidelines. 32 Results from our study shed some light on several issues regarding the clinical use of antiemetics in patients receiving HEC in the United States.…”