Title

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

Authors

Caroline Diorio, Children's Hospital of Philadelphia, Philadelphia, PA
Julie Vardaro, Children's Hospital of Philadelphia, Philadelphia, PA
Yahui Wei, Children's Hospital of Philadelphia, Philadelphia, PA
Jane Mauro, Children's Hospital of Philadelphia, Philadelphia, PA
Colleen Croy, Children's Hospital of Philadelphia, Philadelphia, PA
Katelyn E Oranges, Children's Hospital of Philadelphia, Philadelphia, PA
Lindsay Flanagan, Children's Hospital of Philadelphia, Philadelphia, PA
Anne F Reilly, Children's Hospital of Philadelphia, Philadelphia, PA
L Charles Bailey, Children's Hospital of Philadelphia, Philadelphia, PA
Tracey Jubelirer, Children's Hospital of Philadelphia, Philadelphia, PA
Caitlin W Elgarten, Children's Hospital of Philadelphia, Philadelphia, PA
Jason L Freedman, Children's Hospital of Philadelphia, Philadelphia, PA

Publication Title

JCO Oncol Pract

Document Type

Article

PubMed ID

34705478

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.

Funding Information

None.

Keywords

Antiemetics, Antineoplastic Agents, Aprepitant, Child, Nausea, Neoplasms, Vomiting, Pediatric Oncology, Chemotherapy

DOI

10.1200/OP.21.00476

Publication Date

3-1-2022

Citation

Diorio, C., Vardaro, J., Wei, Y., Mauro, J., Croy, C., Oranges, K., Flanagan, L., Reilly, A., Bailey, L., Jubelirer, T., Elgarten, C., & Freedman, J. (2022). Improving Guideline-Congruent Care for Chemotherapy-Induced Nausea and Vomiting Prophylaxis in Pediatric Oncology Patients.. JCO Oncol Pract, 18 (3), 412-412. https://doi.org/10.1200/OP.21.00476