11266
A Nursing Staff's Approach to Improving Antiemetic Prophylaxis in Hematopoietic Stem Cell Transplant
Bone marrow transplant nurses and pharmacists assessed whether an antiemetic, aprepitant, demonstrated efficacy and safety to use as prophylaxis during transplant. Secondary motives explored both pharmacologic and non-pharmacologic interventions to improve chemotherapy-induced nausea and vomiting.
Significance:
Despite advances in antiemetics, nausea and vomiting remain a major side effect of bone marrow transplant. While practice guidelines suggest aprepitant use with highly emetogenic chemotherapy regimens, lack of research in the transplant setting make providers wary of using it as standard of care.
Strategy and Implementation:
To gather support for the consideration of aprepitant, a chart review evaluating the use of scheduled and PRN antiemetics of past transplant patients was conducted. An alarming mean of 103 antiemetics, most of which were PRN benzodiazepines, were used to manage chemotherapy-induced nausea and vomiting (CINV) during bone marrow transplant – likely contributing to delirium, patient falls, and polypharmacy. Nurses advocated for the further exploration of apreptiant use. A literature review was then conducted suggesting that while aprepritant demonstrates efficacy within the bone marrow transplant population, only one study included safety and drug-drug interactions with other regimen-related toxicities. In lieu of aprepitant, our team utilized pharmacologic options such as low-dose lorazepam with meals, cannabinoids and corticosteroids. Nonpharmacologic strategies employed by our nursing staff include nutritional consults, reiki therapy, and guided imagery.
Evaluation:
Since aprepitant potentially interacts with crucial agents used during transplant, our focus switched to other pharmacologic and non-pharmacologic interventions. A second chart review will be completed to analyze antiemetic usage for patients transplanted June 2013 through December 2013.
Implications for Practice:
Nurses are key advocators for strategies to minimize CINV, which contributes to not only patient's quality of life during but also after transplant. Collaboration on the use of aprepitant as well as further multidisciplinary strategies can improve CINV in transplant patients' experiences.