Individualized outcome feedback produces voluntary antiemetic prescribing practice changes.
OBJECTIVE
To determine the impact of individualized outcome feedback on antiemetic prescribing practices and compare outcomes of a cost-effective, standardized antiemetic protocol (PROT) to that of customized antiemetic therapy (NONPROT).


METHODS
Prospective, observational study with randomized component.


METHODS
Postanesthesia care unit (PACU) of an academic medical center.


METHODS
3027 consecutive ASA physical status I, II, and III patients receiving general anesthesia.


METHODS
Patients were randomized to receive 0.625 mg droperidol or 4 mg ondansetron for postoperative nausea and/or vomiting (PONV) from a protocol, or received customized antiemetic therapy.


RESULTS
Incidence of PACU PONV, selection of PROT versus NONPROT, patient satisfaction, and use of PONV prophylaxis were measured and indexed by an attending anesthesiologist in a monthly report for 4 months. Monthly expenditures for antiemetic therapy prior to, during, and after the study were collected. Literature on PONV outcomes, appropriate timing, and selection of PONV prophylaxis was distributed. The NONPROT group was slightly older than the PROT group; otherwise, demographics were similar between all groups. The incidence of PONV did not differ between the PROT and NONPROT groups (11% vs. 10%), and the incidence of PONV in patients receiving prophylaxis was higher in both groups (17% PROT vs. 15% NONPROT). Patients receiving ondansetron as a first-line drug required rescue therapy less often (5%) than those receiving droperidol (14%); however, patient satisfaction was indistinguishable among all groups. During the study, the use of prophylaxis decreased 47% without an increase in PONV, and PROT selection increased 54%.


CONCLUSIONS
Individualized outcome feedback produced a 48% reduction in monthly expenditures for ondansetron and droperidol, which was sustained after 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 efficacy of ondansetron as a first-line drug.
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston 29425-2207, USA.
F J
FJ
Overdyk
S C
SC
Harvey
D
D
Baldwin
P
P
Rust
M
M
Multani
J
J
Marcell
D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D004329:Droperidol / Q000627:therapeutic use*; D011307:Drug Prescriptions; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014836:Volition
D000932:Antiemetics; D017294:Ondansetron; D004329:Droperidol