Individualized outcome feedback produces voluntary antiemetic prescribing practice changes

Study Objective: To determine the impact of individualized outcome feedback on antiemetic prescribing practices and compare outcomes of a cost-effecti ve, standardized antiemetic protocol (PROT) to that of customized antiemeti c therapy (NONPROT). Design: Prospective, observational study with randomized component. Setting: Postanesthesia care unit (PACU) of an academic medical center. Patients: 3027 consecutive ASA physical status I, II, and III patients rece iving general anesthesia. Interventions: Patients were randomized to receive 0.625 mg droperidol or 4 mg ondansetron for postoperative nausea and/or vomiting (PONV) from a prot ocol, or received customized antiemetic therapy. Measurements and Main Results: Incidence of PACU PONV, selection of PROT ve rsus NONPROT, patient satisfaction, and use of PONV prophylaxis were measur ed and indexed by an attending anesthesiologist in a monthly report for 4 m onths. Monthly expenditures for antiemetic therapy prior to, during, and af ter the study were collected. Literature on PONV outcomes, appropriate timi ng, and selection of PONV prophylaxis was distributed. The NONPROT group wa s slightly older then the PROT group; otherwise, demographics were similar between all groups. The incidence of PONV did not differ between the PROT a nd NONPROT groups (11% vs. 10%), and the incidence of PONV in patients rece iving prophylaxis was higher in both groups (17% PROT vs. 15% NONPROT). Pat ients receiving ondansetron aas a first-line drug required rescue therapy l ess often (5%) than those receiving droperidol (14%); however, patient sati sfaction was indistinguishable among all groups. During the study, the use of prophylaxis decreased 47% without an increase in PONV, and PROT selectio n increased 54%. Conclusions: Individualized outcome feedback produced a 48% reduction in mo nthly expenditures for ondansetron and droperidol, which was sustained afte r the study. Patients satisfaction between ondansetron 4 mg and droperidol 0.625 mg given in the PACU did not differ in spite of a slightly greater ef ficacy of ondansetron as a first-line drug.