Improving antiemetic guideline adherence for adult patient’s receiving highly emetogenic chemotherapy (HEC)

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  • March 20, 2019
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  • Mellin, Corrine
    • Affiliation: School of Nursing
Abstract
  • A quality improvement project was implemented to improve adherence to evidence based antiemetic guidelines for patient receiving HEC, and ultimately improve the rates of chemotherapy induced nausea and vomiting. Chemotherapy induced nausea and vomiting (CINV) can be prevented in 70-80% of cases when guidelines are followed; however, despite being recently updated, there is evidence that guideline utilization is less than optimal. Two potential reasons for inadequate CINV guideline adherence is provider lack of knowledge and/or how to implement them into practice. Methods: A retrospective chart analysis prior to the intervention was performed on 86 patients to assess for the presence of CINV and use of antiemetics. Pre-intervention, an electronic anonymous survey was provided to nurses and APP’s. In-person education interventions were provided to nurses and APP’s over one month. An immediate post and three month post-intervention survey was provided to RN’s and APP’s. Three months post-implementation, a retrospective chart analysis was performed on 37 patients to again assess for presence of CINV and use of antiemetics. Results: In a pre-intervention chart review of the 86 patients, 42 (48.8%) experienced CINV with only 6 (7%) receiving guidelines appropriate antiemetic prophylaxis. Out of 82 nurses, 60 participated in the pre-intervention survey scoring an average percent correct of 57.7%, and five of six APP’s participating scoring an average of 60.8%. Immediately post-intervention 55 of 78 nurse participated scoring an average percent correct of 66.1%, and all six APP’s participated scoring 71.9%. Three months post-intervention 41 of 74 nurses participated scoring an average of 66.2%, and five of the six APP’s participated scoring a 70.8%. Of the 37 patients selected for three months post-intervention chart review, 14 (37.8%) experienced CINV with 8 (21.6%) receiving guideline appropriate antiemetic prophylaxis. Conclusion: The study demonstrates an effective approach in improve provider adherence to antiemetic guidelines, which resulted in a decrease in the rates of CINV. Findings also demonstrate the need for guideline reinforcement and continuing education on recent updates and chart audits to ensure continued adherence, allowing for the best evidence base care to be provided to patients.
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  • In Copyright
Advisor
  • Mayer, Deborah
  • Bryant, Ashley
  • Mason, Susan
Degree
  • Doctor of Nursing Practice
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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