AUDIT OF GUIDELINES FOR EFFECTIVE CONTROL OF CHEMOTHERAPY AND RADIOTHERAPY-INDUCED EMESIS

A system was devised to establish the optimum treatment for emesis for each individual child receiving cytotoxic treatment. Cytotoxic drugs were ranked on a scale (1-5), with antiemetic regimens correspondingly graded. An age division (less than or equal to 5 years, >5 years) was included. Cytotoxic treatment was given with coadministration of the parallel antiemetic regimen. Failure to control emesis required admini strtion of a stronger regimen as defined in the guidelines. A prospect ive clinical audit was performed to monitor the efficacy and utility o f the system using diary cards to record episodes of nausea or vomitin g, or both, completed by the patient or a parent and the nursing staff . The following audit criteria were set: (a) 80% control with first co urses of chemotherapy; (b) 85% control with subsequent courses of simi lar chemotherapy; and (c) 90% lack of anticipatory nausea. Sixty child ren (<18 years) received emetogenic cytotoxic drugs from February-June 1993. The criteria were satisfied in two of three categories, with 82 % control for first courses of chemotherapy, 83% control for subsequen t courses of chemotherapy, and 90% lack of anticipatory nausea. The gu idelines were workable and acceptable overall. Minor modifications hav e been made subsequent to the audit to improve their efficacy further.