Advanced Practice Nursing Intervention to Reduce Chemotherapy-Induced Nausea and Vomiting

Chemotherapy-induced nausea and vomiting (CINV) occurs in 70-90% of those receiving moderate-to-high emetogenic chemotherapy (Mastrangelo, 2018; Ranganath et al., 2015). Early management of chemotherapy side effects improves patient outcomes and decreases hospitalizations. The purpose of this DNP project was to utilize an evidence-based strategy to minimize CINV and to reduce the number of health care visits related to CINV over a 16-week period. The Iowa Model provided the framework for this project. A literature search was conducted of five databases, which yielded nine relevant articles. Evidence levels include four level II, four level VI, and one level VII, according to Melnyk and Fineout-Overholt’s (2015) hierarchy of evidence. The JHNEBP Research Appraisal Tools were used to appraise the evidence: seven pieces of evidence were rated high quality and two pieces were rated good quality. For this project, treatment naïve patients receiving moderate or high emetogenic chemotherapy received telephone calls on Days 2, 3, and 10 post-chemotherapy. The Rhodes Index of Nausea, Vomiting, and Retching (INVR) questionnaire was administered during each call and additional interventions were recommended based on INVR scores. The findings show that a telephone intervention and administration of a nausea questionnaire, while not necessarily decreasing overall CINV scores, did address symptoms in a cost-effective manner. There was an increase in infusion center visits that attributed to a decrease in ED visits and hospitalizations. Six of the 45 comparison group patients required hospitalizations for CINV (13.33%), compared to 1 of the 24 intervention group participants (4.17%)