ASSURING THE OPTIMAL USE OF SEROTONIN ANTAGONIST ANTIEMETICS - THE PROCESS FOR DEVELOPMENT AND IMPLEMENTATION OF INSTITUTIONAL ANTIEMETIC GUIDELINES AT MEMORIAL SLOAN-KETTERING-CANCER-CENTER

Purpose: The need to foster the appropriate and cost-effective use of serotonin-antagonist antiemetic drugs spurred the creation of guidelin es. The process by which institution-wide guidelines at Sloan-Ketterin g were developed, implemented, assessed, and modified is described. Me thods: A multidisciplinary group working with disease-specific managem ent teams assigned the emetic potential of chemotherapy programs to on e of five categories. Antiemetic regimens, including a specified dose and schedule of a serotonin-antagonist and dexamethasone, were assigne d to each emetic category. The information was collated by disease sit e and chemotherapy program into hospital-wide antiemetic regimen recom mendations. Quality assessment was conducted initially and repeated ea ch time the guidelines were modified. Results: Patient surveys demonst rated a high level of satisfaction with emetic control, which was simi lar to reported results. Data from the latest survey showed zero emeti c episodes in 93% and 87% of participants given moderate and highly em etogenic chemotherapy, respectively. Compliance with the guidelines, i nitially in 73%, has been improved using a standardized chemotherapy o rder ''check box'' labeled, ''Antiemetics as per Guidelines.'' Antieme tic drug expenditures decreased from a projected $2.8 million to $1.3 million annually. Conclusion: The guidelines became an educational too l that ensured the delivery of optimal antiemetic therapy chosen by pr ofessionals with the greatest knowledge of both the particular chemoth erapy regimen and cancer site. Implementation of the guidelines result ed in substantial savings while treating more patients. The guidelines were easily modified as new chemotherapeutic agents and antiemetic dr ugs became available. (C) 1998 by American Society of Clinical Oncolog y.