title: Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice.
abstract: OBJECTIVE
  A quality improvement project was implemented to improve adherence to evidence-based antiemetic guidelines for malignant glioma patients treated with moderately emetic chemotherapy (MEC). Poorly controlled chemotherapy-induced nausea and vomiting (CINV) reduce cancer treatment efficacy and significantly impair cancer patients' quality of life (QOL). A review of Duke University Preston Robert Tisch Brain Tumor Center (PRTBTC)'s usual practice demonstrates a high incidence (45%) of CINV, despite premedication with short-acting 5-HT3-serotonin-receptor antagonists (5-HT3-RAs). National Comprehensive Cancer Network (NCCN)'s evidence-based guidelines recommend the combination of the long-acting 5-HT3-RA palonosetron (PAL) and dexamethasone (DEX) for the prevention of acute and delayed CINV with MEC. Low adherence (58%) to antiemetic guidelines may have explained our high CINV incidence.
  
  
  METHODS
  One-sample binomial test, quasi-experimental design, evaluated a combination intervention that included a provider education session; implementation of risk-assessment tool with computerized, standardized antiemetic guideline order sets; and a monthly audit-feedback strategy. Post-implementation adherence to evidence-based antiemetic order sets and patient outcomes were measured and compared to baseline and historical data. Primary outcome was the guideline order set adherence rate. Secondary outcomes included nausea/vomiting rates and QOL.
  
  
  RESULTS
  Adherence to ordering MEC guideline antiemetics increased significantly, from 58% to a sustained 90%, with associated improvement in nausea/vomiting. In acute and delayed phases, 75 and 84% of patients, respectively, did not experience CINV. There was no significant change in QOL.
  
  
  CONCLUSIONS
  Combination intervention and audit-feedback strategy to translate evidence into oncology practice improved and sustained adherence to antiemetic guidelines. Adherence corresponded with effective nausea/vomiting control and preserved QOL in patients with malignant gliomas.
authors.affiliation: Department of Surgery, Duke University Health System, Durham, NC, 27710, USA, mary.affronti@duke.edu.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Affronti
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schneider
authors.forename: James E
authors.initials: JE
authors.lastname: Herndon
authors.forename: Susan
authors.initials: S
authors.lastname: Schlundt
authors.forename: Henry S
authors.initials: HS
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy*; D006801:Humans; D007546:Isoquinolines / Q000008:administration & dosage; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy; D000077924:Palonosetron; D011788:Quality of Life; D011812:Quinuclidines / Q000008:administration & dosage; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000008:administration & dosage; D057170:Translational Research, Biomedical; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D007546:Isoquinolines; D011812:Quinuclidines; D058831:Serotonin 5-HT3 Receptor Antagonists; D000077924:Palonosetron; D003907:Dexamethasone