Implementation of National Pediatric Guidelines to Prevent Chemotherapy Induced Nausea and Vomiting in Children with Cancer

Purpose: The purpose of this study was to assess the use of supplemental, as needed (prn) pharmacologic interventions for uncontrolled acute chemotherapy induced nausea and vomiting (CINV) in children with cancer after implementation of new pediatric CINV prophylaxis guidelines. Description of Project: A retrospective chart review was completed on forty-three children admitted to the hospital for chemotherapy during a 3 month period in 2017 to document the use of medications given for acute breakthrough CINV. The pre-implementation group received anti-emetics based on the institutional standard of care. A second retrospective chart review was completed on thirty-three children admitted to the hospital for chemotherapy during a 3 month period in 2018 to evaluate use of medications for acute breakthrough CINV. The post-implementation group received anti-emetics based on the new published pediatric guidelines. Patient characteristics, treatment information, and provider compliance with guidelines were collected. Results/Conclusions: Implementation of the guideline by the institution was successful with 91% of patients in the post-intervention group receiving the new anti-emetic regimen to prevent nausea and vomiting. The mean anti-emetic dose in all patients for breakthrough CINV pre-implementation was 4.837±10.4857. Post-implementation, the mean anti-emetic dose for all patients was 3.394±6.432. This was not statistically significant (p =0.462). For patients under 12, the mean anti-emetic dose pre-implementation was 5.8±12.5333 and post-implementation was 3.882±8.1. This was also not statistically significant (p =0.55). Data collected from this project did demonstrate a decrease in the number of breakthrough anti-emetics used in children under 12 years of age likely related to the addition of the drug aprepitant. Although clinical guidelines provide excellence guidance to clinicians, they must always be evaluated for risk versus benefit; adapted to individual patient circumstances as appropriate; and used within the context of expert clinician judgement