Assuring the optimal use of serotonin antagonist antiemetics: The process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center
Assuring the optimal use of serotonin antagonist antiemetics: The process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center
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DOI：
10.1200/jco.1998.16.2.771
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发表时间：
1998-02-01
影响因子：
45.3
通讯作者：
Kris, MG
中科院分区：
文献类型：
--
作者：
Nolte, MJ;Berkery, R;Kris, MG
目的：促进正确且经济有效地使用 5-羟色胺拮抗剂止吐药的需要促使指南的制定。描述了斯隆-凯特琳医院制定、实施、评估和修改全机构指南的过程。方法：与特定疾病管理团队合作的多学科小组将化疗方案的催吐潜力分配为五个类别之一。止吐方案，包括特定剂量和时间表的血清素拮抗剂和地塞米松，被分配到每个催吐类别。这些信息按疾病部位和化疗方案整理成全院止吐方案建议。最初进行质量评估，并在每次修改指南时重复进行。结果：患者调查显示患者对催吐控制的满意度很高，这与报告的结果相似。最新调查数据显示，接受中度致吐化疗和高度致吐化疗的参与者中，分别有 93% 和 87% 的参与者出现零呕吐。使用标有“按照指南止吐”的标准化化疗医嘱“复选框”后，指南的依从性最初为 73%。止吐药物支出从每年预计的 280 万美元减少到 130 万美元。结论：该指南成为一种教育工具，确保由最了解特定化疗方案和癌症部位的专业人员选择最佳的止吐治疗。该指南的实施在治疗更多患者的同时节省了大量成本。随着新的化疗药物和止吐药物的出现，这些指南很容易被修改。 (C) 1998 年美国临床肿瘤学会。
Purpose: The need to foster the appropriate and cost-effective use of serotonin-antagonist antiemetic drugs spurred the creation of guidelines. The process by which institution-wide guidelines at Sloan-Kettering were developed, implemented, assessed, and modified is described.Methods: A multidisciplinary group working with disease-specific management teams assigned the emetic potential of chemotherapy programs to one of five categories. Antiemetic regimens, including a specified dose and schedule of a serotonin-antagonist and dexamethasone, were assigned to each emetic category. The information was collated by disease site and chemotherapy program into hospital-wide antiemetic regimen recommendations. Quality assessment was conducted initially and repeated each time the guidelines were modified.Results: Patient surveys demonstrated a high level of satisfaction with emetic control, which was similar to reported results. Data from the latest survey showed zero emetic episodes in 93% and 87% of participants given moderate and highly emetogenic chemotherapy, respectively. Compliance with the guidelines, initially in 73%, has been improved using a standardized chemotherapy order "check box" labeled, "Antiemetics as per Guidelines." Antiemetic drug expenditures decreased from a projected $2.8 million to $1.3 million annually.Conclusion: The guidelines became an educational tool that ensured the delivery of optimal antiemetic therapy chosen by professionals with the greatest knowledge of both the particular chemotherapy regimen and cancer site. Implementation of the guidelines resulted in substantial savings while treating more patients. The guidelines were easily modified as new chemotherapeutic agents and antiemetic drugs became available. (C) 1998 by American Society of Clinical Oncology.