Congress Abstracts 2003

68

IMPROVING THE USE OF ANTIEMETICS FOR PROPHYLAXIS OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN AN OUTPATIENT CANCER CENTER. Elizabeth Prechtel, RN, MSN, CRNP, AOCN^®, and Suzanne Walker, RN, MSN, CRNP, AOCN^®, Temple University, Philadelphia, PA.

Although the prevention of chemotherapy-induced nausea and vomiting (CINV) has markedly improved since the introduction of 5HT-3 inhibitors in the early 1990s, patients still report nausea as being the most distressing side effect of chemotherapy. A possible explanation for this perception is the inappropriate prescription of antiemetics by clinicians. Despite the fact that guidelines for prophylaxis of CINV have been published by the American Society of Clinical Oncology (ASCO), American Society of Hospital Pharmacists (ASHP), and the National Comprehensive Cancer Network (NCCN), studies indicate that antiemetics are still being prescribed incorrectly by providers. They are being under utilized, particularly in prevention of delayed emesis, and over utilized for mildly emetogenic agents. In our practice, we are in the process of conducting a drug utilization evaluation (DUE) based on anecdotal evidence that antiemetics have been prescribed inconsistently for CINV by our providers. Preliminary data indicate that few patients are getting antiemetic prophylaxis for delayed emesis and that patients receiving chemotherapy agents of low emetogenic potential are being overmedicated. The implications of insufficient prophylaxis include uncontrolled nausea and vomiting, and the disadvantages of excessive prophylaxis are inflated cost and the potential for unwarranted adverse effects. The goal of this DUE is to apply the findings to our clinical practice by educating the providers and nurses regarding the proper use of antiemetics with chemotherapy, utilizing the ASHP guidelines as our model. A summary of the guidelines will be placed in the clinic area where chemotherapy orders are written, as well as in the pharmacy and the nurses’ station. We plan to repeat the DUE in three months to determine if prescribing practices were positively influenced by this information.