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. 2014 Jul;22(7):1897-905.
doi: 10.1007/s00520-014-2136-0. Epub 2014 Feb 26.

Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

Mary Lou Affronti  1 , Susan M Schneider, James E Herndon 2nd, Susan Schlundt, Henry S Friedman
Affiliations

Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

Mary Lou Affronti et al. Support Care Cancer. 2014 Jul.

Abstract

Purpose: A quality improvement project was implemented to improve adherence to evidence-based antiemetic guidelines for malignant glioma patients treated with moderately emetic chemotherapy (MEC). Poorly controlled chemotherapy-induced nausea and vomiting (CINV) reduce cancer treatment efficacy and significantly impair cancer patients' quality of life (QOL). A review of Duke University Preston Robert Tisch Brain Tumor Center (PRTBTC)'s usual practice demonstrates a high incidence (45%) of CINV, despite premedication with short-acting 5-HT3-serotonin-receptor antagonists (5-HT3-RAs). National Comprehensive Cancer Network (NCCN)'s evidence-based guidelines recommend the combination of the long-acting 5-HT3-RA palonosetron (PAL) and dexamethasone (DEX) for the prevention of acute and delayed CINV with MEC. Low adherence (58%) to antiemetic guidelines may have explained our high CINV incidence.

Methods: One-sample binomial test, quasi-experimental design, evaluated a combination intervention that included a provider education session; implementation of risk-assessment tool with computerized, standardized antiemetic guideline order sets; and a monthly audit-feedback strategy. Post-implementation adherence to evidence-based antiemetic order sets and patient outcomes were measured and compared to baseline and historical data. Primary outcome was the guideline order set adherence rate. Secondary outcomes included nausea/vomiting rates and QOL.

Results: Adherence to ordering MEC guideline antiemetics increased significantly, from 58% to a sustained 90%, with associated improvement in nausea/vomiting. In acute and delayed phases, 75 and 84% of patients, respectively, did not experience CINV. There was no significant change in QOL.

Conclusion: Combination intervention and audit-feedback strategy to translate evidence into oncology practice improved and sustained adherence to antiemetic guidelines. Adherence corresponded with effective nausea/vomiting control and preserved QOL in patients with malignant gliomas.

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Figures

Fig. 1
Fig. 1
Standardized computerized order-set with primary risk (emetogenicity level) assessment
Fig. 2
Fig. 2
Monthly adherence to antiemetic guideline: 1 Adherence was 41% over a 1-year period 6 months prior to implementation; 2 Adherence was 58% over a 3-month baseline period to match project period
See this image and copyright information in PMC

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