{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T20:38:39Z","timestamp":1772224719911,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,1,15]],"date-time":"2023-01-15T00:00:00Z","timestamp":1673740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chemotherapy\u2010induced nausea and vomiting (CINV) is a distressing adverse effect in children receiving cancer treatment. There are evidence\u2010based pediatric clinical practice guidelines (CPG) on chemotherapy emetogenicity and acute CINV prevention, but adherence to these guidelines is low.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>A quality improvement\u2010based 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 emetogenic chemotherapy (MEC) from baseline 25% to more than 70% by June 2021. Barriers were identified by process mapping, and a series of interventions were implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Guideline adherence was assessed in 270 inpatient chemotherapy administrations (HEC, MEC). Data were collected on 131 charts pre interventions and 139 charts post interventions. Interventions included education, addition of guideline\u2010recommended anti\u2010emetics to the inpatient formulary, and implementation of a standardized CPG tool. Initial rates of total CINV guideline adherence were 25%, which improved to 72% post intervention (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001). In subgroup analysis, guideline adherence in the MEC group improved from 13% to 34% (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.015), and in the HEC group from 32% to 93% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001). The most common reason for nonadherence in the HEC group was failure to use aprepitant as anti\u2010emetic, and in MEC was option for ondansetron monotherapy prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30210","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T07:11:14Z","timestamp":1673853074000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Addressing adherence to guidelines on prevention of acute chemotherapy\u2010induced nausea and vomiting in pediatric patients"],"prefix":"10.1002","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2519-350X","authenticated-orcid":false,"given":"Marija","family":"Kacar","sequence":"first","affiliation":[{"name":"Division of Solid Tumors St. Jude Children's Research Hospital  Memphis Tennessee USA"},{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology McMaster Children's Hospital Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology McMaster Children's Hospital  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology McMaster Children's Hospital  Hamilton Ontario Canada"},{"name":"Department of Pediatrics McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010009\u20100651\u20101"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27646"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/jop.2012.000816"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23114"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24508"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25063"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25955"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26542"},{"issue":"3","key":"e_1_2_9_10_1","first-page":"303","article-title":"Management of patients with chemotherapy\u2010induced nausea and vomiting","volume":"8","author":"Barbour SY","year":"2017","journal-title":"J Adv Pract Oncol"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27899"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27488"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_9_14_1","unstructured":"Across the chasm: six aims for changing the health care system.Institute for Healthcare Improvement;2022. 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