Improving Guideline-Congruent Care for Chemotherapy-Induced Nausea and Vomiting Prophylaxis in Pediatric Oncology Patients

Abstract

PURPOSE Chemotherapy-induced nausea and vomiting (CINV) is a very common side effect of pediatric cancer therapy. High-quality, evidence-based, pediatric-specific guidelines for prophylaxis and treatment of CINV are available. At many centers, guideline-concordant care is uncommon. We formed a multidisciplinary quality improvement team to implement guideline-concordant care for CINV prophylaxis at our center. We present the results following the first year of our interventions. METHODS We planned and implemented a multipronged approach in three key phases: (1) developing and publishing an acute CINV prophylaxis pathway, (2) education of providers, and (3) updating the computerized provider order entry system. We used iterative, sequential Plan-Do-Study-Act cycles and behavioral economic strategies to improve adherence to guideline-concordant CINV prophylaxis. We focused on aprepitant usage as a key area for improvement. RESULTS At the beginning of the study period, < 50% of patients were receiving guideline-concordant CINV prophylaxis and < 15% of eligible patients were receiving aprepitant. After 1 year, more than 60% of patients were receiving guideline-concordant care and 50% of eligible patients were receiving aprepitant. CONCLUSION We describe the development and implementation of a standardized pathway for prevention of acute CINV in pediatric oncology patients. With a multidisciplinary, multifaceted approach, we demonstrate significant improvements to guideline-congruent CINV prophylaxis.

Pediatric oncology provider perspectives and patient/family perceptions of chemotherapy‐induced nausea and vomiting management: Experiences at an academic medical center

“…Additionally, standardizing the process by which CPGs are adapted on an institutional level through the creation of a care pathway may help improve patient outcomes. [12][13][14][15] A recent study demonstrated increased guidelineconcordant CINV management with the implementation of a clinical practice pathway and changes to computerized provider order entry. 15 In this study, there was no significant difference in patient/familyreported CINV symptoms based on patient factors including sex, age, and ethnicity.…”

“…[12][13][14][15] A recent study demonstrated increased guidelineconcordant CINV management with the implementation of a clinical practice pathway and changes to computerized provider order entry. 15 In this study, there was no significant difference in patient/familyreported CINV symptoms based on patient factors including sex, age, and ethnicity. Importantly, at our hospital with a high proportion of Spanish-speaking patients, there was no association between preferred language or ethnicity, and CINV symptoms.…”

“…In fact, providers in this study were most interested in a standardized assessment tool in the electronic medical record. Additionally, standardizing the process by which CPGs are adapted on an institutional level through the creation of a care pathway may help improve patient outcomes 12–15 . A recent study demonstrated increased guideline‐concordant CINV management with the implementation of a clinical practice pathway and changes to computerized provider order entry 15 …”

Efficacy of vitamin B1 in alleviating chemotherapy-induced nausea and vomiting

“…Chemotherapy-induced nausea and vomiting (CINV) is one of the most common adverse effects that affect the quality of life of patients and demand considerable medical resources [2]. Recently, several antiemetic agents have become available, and several studies focusing on CINV have been conducted [3,4]. However, methods to prevent and manage breakthrough or refractory CINV have not yet been established.…”