Impact of guidelines implemented in a Paris university hospital: application to the use of antiemetics by cancer patients

Aims To assess the impact with time of guidelines on antiemetic use in an 8 50-bed Paris university hospital with a high proportion of cancer patients. Methods Guidelines on the use of antiemetics available in cancer chemothera py were drafted according to the Delphi technique. Their implementation was based upon a patient-specific antiemetic prescription form. To assess the impact of guideline implementation overtime, discrepancies between current practice and the guidelines were compared before guideline implementation ( between March and August 1995) and after implementation (between March and August 1997, and March and August 1998). Results Before the Delphi panel's guidelines were implemented, 5-HT3 antago nists were inappropriately administered in 70% of cases. After guideline im plementation, this proportion dropped significantly (P < 0.0001, Fisher's e xact test) to 22% between March and August 1997 and 28% between March and A ugust 1998. Conclusions Implementation of guidelines seems to have resulted in signific ant changes with me, although a causal relationship has not been demonstrat ed. The development of guidelines by our hospital's multidisciplinary worki ng group helped the various consultants to adjust medical practices to take account of these changes.