MEDICATION USE EVALUATION
Summary of Overall Results
Antiemetic: January-February 20XX
Background: This topic was selected based on high use, potential misuse, and high cost of these agents. Criteria for this evaluation were approved at the MUE Committee’s December 20XX meeting. Please refer to attached criteria for additional information.
Total Patients Evaluated (All Indications for Use) = 52
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|Element ||Standard ||Results ||Compliance |
|Indication for use ||95% ||OVERALL RESULTS || |
| || ||Treatment/prevention of nausea/ vomiting (N/F) associated with chemotherapy ||100% (52/52) |
| || ||Highly emetogenic chemotherapy ||46/46 |
| || ||Anticipatory N/V associated with chemotherapy ||6/6 |
|Dosing ||95% ||OVERALL RESULTS ||71% (37/52) |
| || || Highly emetogenic chemotherapy ||31/46 |
| || || Anticipatory N/V associated with chemotherapy ||6/6 |
|Adverse drug reaction(s) ||< 10-25% (varies with ADR) ||OVERALL RESULTS: ||4% (2/52) |
| || ||Headache: 1 patient || |
| || ||Constipation: 1 patient || |
|Prevention of nausea and emesis ||95% ||OVERALL RESULTS ||92% (46/50)∗ |
| || || Highly emetogenic chemotherapy ||41/44 |
| || || Anticipatory N/V associated with chemotherapy ||5/6 |
|Chemotherapy course not interrupted ||95% ||OVERALL RESULTS (ALL INDICATIONS) ||100% (52/52) |
Prescribing: Criteria for indication for use were met in all cases.
Dispensing/Administering: Criteria for dosing was met in 37 of 52 cases with all cases involving anticipatory nausea and vomiting meeting criteria.
In 15 cases, patients receiving the antiemetic prior to highly emetogenic chemotherapy received doses not included in the approved criteria. Five of these patients received doses based on an investigational protocol. This dose is now under consideration by the FDA for approval and preliminary results (available only in abstract form) were recently presented at the American Society of Clinical Oncology meeting. Results with the new dosing regimen have been comparable to those with the currently approved doses.
In seven cases not meeting dosing criteria, patients received a single dose prior to chemotherapy consistent with the criteria. However, an additional dose was administered 24 hours after the first dose. These orders were written by two prescribers.
Two cases did not meet dosing criteria because the dose was not adjusted based on renal dysfunction. In both cases, the estimated creatinine clearance was between 20 and 25 mL/min and nephrotoxic drugs were not being administered concurrently. In both cases, the estimated creatinine clearance increased to 30 mL/min or more by day two of the admission (probably due to rehydration of the patient). Neither patient experienced adverse effects.
One dose was not administered within the appropriate timeframe. In this case, the antiemetic dose was administered just 5 minutes prior to the initiation of chemotherapy administration. The nurse administering the antiemetic documented its administration on the way to the patient’s room. When ...