ASSURING THE OPTIMAL USE OF SEROTONIN ANTAGONIST ANTIEMETICS - THE PROCESS FOR DEVELOPMENT AND IMPLEMENTATION OF INSTITUTIONAL ANTIEMETIC GUIDELINES AT MEMORIAL SLOAN-KETTERING-CANCER-CENTER
Mj. Nolte et al., ASSURING THE OPTIMAL USE OF SEROTONIN ANTAGONIST ANTIEMETICS - THE PROCESS FOR DEVELOPMENT AND IMPLEMENTATION OF INSTITUTIONAL ANTIEMETIC GUIDELINES AT MEMORIAL SLOAN-KETTERING-CANCER-CENTER, Journal of clinical oncology, 16(2), 1998, pp. 771-778
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.