title: Antiemetic prescribing practices using a computerized physician order entry system.
abstract: OBJECTIVE
  Adherence to guideline-consistent chemotherapy-induced nausea and vomiting (CINV) prophylaxis is suboptimal. The primary aim of this study was to evaluate the magnitude of compliance to institutional guideline-directed antiemetic prophylaxis using a computerized physician order entry system at a single tertiary care institution. A nurse survey was also performed to evaluate how oncology practices, within a cooperative group, managed clinician orders for the prevention of CINV.
  
  
  METHODS
  The electronic medical records of 100 consecutive patients were evaluated. The primary endpoint was the incidence of compliance to provide all aspects of scheduled institutional guideline-directed antiemetic prophylaxis for acute (day 1) and delayed (days 2-4) CINV. A descriptive analysis was performed on the convenience sample. Logistic regression was completed to determine the predictors of noncompliance.
  
  
  RESULTS
  The incidence of compliance on days 1-4 was 94 %. Half of the noncompliant events (three of six, 50 %) occurred on day 1 alone and involved patients receiving low-emetogenic chemotherapy. There was a high degree of compliance to institutional guidelines for the treatment of delayed CINV (97 %). Patients receiving minimally emetogenic and moderately emetogenic chemotherapy (N = 70) were observed to be 100 % compliant. Patients receiving doxorubicin/cyclophosphamide were numerically less likely to receive institutional guidelines, compared to patients receiving other chemotherapy regimens (OR, 0.24 (0.04, 1.36), p value, 0.05). The nurse survey suggested significant variability amongst the involved institutions with regards to antiemetic prescribing practices.
  
  
  CONCLUSIONS
  Computerized physician order entry is associated with impressive adherence to clinician-prescribing practices, according to institutional guidelines, for acute and delayed CINV.
authors.affiliation: Division of Internal Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN, 55905, USA, kunkadak13@gmail.com.
authors.forename: Kunal C
authors.initials: KC
authors.lastname: Kadakia
authors.forename: Alexis D
authors.initials: AD
authors.lastname: Leal
authors.forename: Drew K
authors.initials: DK
authors.lastname: Seisler
authors.forename: Rui
authors.initials: R
authors.lastname: Qin
authors.forename: Kelliann C
authors.initials: KC
authors.lastname: Fee-Schroeder
authors.forename: Darryl C
authors.initials: DC
authors.lastname: Grendahl
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Sorgatz
authors.forename: Charles L
authors.initials: CL
authors.lastname: Loprinzi
mesh_terms: D000932:Antiemetics / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D010349:Patient Compliance; D012189:Retrospective Studies; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000932:Antiemetics
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