Implementing evidence based antiemetic guidelines in the oncology setting:results of a 4-month prospective intervention study

There is a considerable gap between obtaining results in randomized trials and implementing them into practice. This is particularly relevant with the high-cost 5HT3 antiemetics, which include ondansetron, dolasetron and gran isetron. Randomized trial data suggests that they should be used as a singl e daily dose during only the first 24 h of chemotherapy because they offer little benefit over less costly agents beyond this period. In this study, s ix intervention methods (i.e. multifaceted approach) were combined to chang e physicians' 5HT3 prescribing patterns to comply with evidence-based antie metic guidelines. A six-step implementation process was adopted, consisting of guideline dissemination, the use of opinion leaders, interactive educat ional workshops, therapeutic reminders in the form of preprinted orders, cl inical interventions by pharmacists for the event of inappropriate antiemet ic orders, and physician audit and feedback. Once implemented, the control of emesis was collected in all patients who were enrolled in the interventi on program. Multivariable regression analysis was then used to assess wheth er prescribing within antiemetic guidelines compromised patient care. A tot al of 195 inpatients were enrolled in the study over the 4-month interventi on period. Overall, 88.7% of granisetron prescriptions fulfilled the guidel ines with respect to appropriate indication, dosage, and duration of therap y. The multivariable analysis suggested that granisetron prescribing within guidelines did not compromise the control of acute and delayed emesis. In addition, patients who received evidence-based antiemetic therapy experienc ed a significant reduction in the severity of acute nausea [risk ratio (RR) = 0.69; P=0.03]. The results of this guideline implementation study reveal ed that a pharmacist-driven multifaceted intervention program for such high -cost agents as 5HT3 antiemetics can promote their use in a clinically appr opriate manner and can save unnecessary drug costs without compromising the quality of patient care.