Clinton, F., Dowling, M., & Capra, M. (2012). An audit of chemotherapy-induced nausea and vomiting in children. Nursing Children and Young People, 24, 18–23.

To document the prescription and administration of antiemetic therapy with a secondary objective of collecting data on the effectiveness of the antiemetic medications being used when possible

After each admission, pediatric patients were interviewed to assess the degree of nausea and vomiting experienced until discharge. The antiemetic medications and chemotherapy they received were documented each day. On the day following discharge, phone calls were made to assess nausea and vomiting and to record antiemetic medications used at home.

• N = 25  
• AGE RANGE = 4–16 years
• MALES: 60%, FEMALES: 40%
• KEY DISEASE CHARACTERISTICS: Variety of cancer diagnoses; aged more than four years

• SITE: Single site    
• SETTING TYPE: Inpatient  
• LOCATION: Our Lady's Children Hospital in Dublin, Ireland

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Prospective audit

Nausea and vomiting were assessed by the Pediatric Nausea Assessment Tool (PeNAT) and the MASCC Antiemesis Tool (MAT).

Most patients received a combination of a 5HT3 antagonist and metoclopramide. One took dexamethasone. There was no apparent association between the antiemetic prescribed and emetogenic potential of the chemotherapy taken. Vomiting increased a little from days one to five of chemotherapy administration in spite of medication, but children mainly reported no or only a little nausea (PeNAT 1 or 2). Three reported more or a lot of nausea (PeNAT 3 or 4). Anticipatory vomiting occurred in two episodes, acute vomiting in 17, and delayed vomiting in 24. Of the 20 children who did not take any antiemetics after discharge, 11 were not prescribed any. Dexamethasone was prescribed for only one patient despite evidence indicating that it should be an essential part of almost all antiemetic regimens.

The discrepancies in prescriptions to manage chemotherapy-induced nausea and vomiting were obvious. The PeNAT scale was easy to manage, but it may not have been efficient for detecting previous experience with younger children. The MAT was easy to comprehend and follow.

• Small sample (< 30)
• Baseline sample/group differences of import
• Measurement validity/reliability questionable
• Findings not generalizable
• Other limitations/explanation: In addition to the limitations of a clinical audit, children aged less than eight years old could not provide retrospective decisions on their nausea in the previous 24 hours, and nausea was difficult.
• It was difficult to assess when the child was discharged from the hospital despite the use of the PeNAT scale at home. Data related to dietary intake and degree of nausea were not obtained in this study. The emetogenic potential of the chemotherapy administered was not taken into consideration.

The timely assessment and prescription of appropriate antiemetics for children is extremely important. Educational support for families regarding the assessment of delayed chemotherapy-induced nausea and vomiting is crucial for the control of symptoms.