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\begin{document}

\title{Addressing adherence to guidelines on prevention of acute chemotherapy
induced nausea and vomiting in pediatric patients}



\author[1]{Marija Kacar}%
\author[2]{Paula MacDonald}%
\author[2]{Paul Gibson}%
\affil[1]{St Jude Children's Research Hospital}%
\affil[2]{McMaster Children's Hospital}%


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  \date{May 24, 2024}


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\begin{abstract}
\textbf{Background:} Chemotherapy induced nausea and vomiting (CINV) is
a distressing adverse effect in children receiving cancer treatment.
There are evidence-based pediatric clinical practice guidelines (CPG) on
chemotherapy emetogenicity and acute CINV prevention, but adherence to
these guidelines is low. \textbf{Procedure:} A quality improvement-based
study was conducted at McMaster Children's Hospital. The SMART aim was
to increase adherence to guidelines on prevention of acute CINV in
hospitalized patients receiving high (HEC) and moderately (MEC)
emetogenic chemotherapy from baseline 25\% to \textgreater{}70\% by June
2021. Barriers were identified by process mapping and a series of
interventions were implemented. \textbf{Results:} Guideline adherence
(GA) was assessed in 270 inpatient chemotherapy administrations (HEC,
MEC). Data was collected on 131 charts pre-interventions and 139 charts
post-interventions. Interventions included education, addition of
guideline recommended anti-emetics to the inpatient formulary and
implementation of a standardized CPG tool. Initial rates of total CINV
GA were 25\%, which improved to 72\% post-intervention (p
\textless{}0.001). In subgroup analysis, GA in the MEC group improved
from 13\% to 34\% (p=0.015), and in the HEC group from 32\% to 93\%
(p\textless{}0.001). The most common reason for non-adherence in the HEC
group was failure to use aprepitant as anti-emetic, and in MEC was
option for ondansetron monotherapy prophylaxis. \textbf{Conclusion:}
Using quality improvement methodology, barriers to guideline adherence
were identified and interventions implemented. Guideline adherence for
prevention of CINV improved, particularly in the HEC group but less for
the MEC group. Future steps will include sustainability of interventions
and addressing adherence in the MEC group.%
\end{abstract}%



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