Background Malignant bowel obstruction is a recognised complication of advanced malignancy. Surgery is not always suitable therefore antiemetics are the mainstay of symptomatic management. There is little evidence for any specific antiemetic. NWAG was initiated to co-ordinate audits across palliative care settings within the north-west.
Aims To review the assessment and management of nausea and vomiting in medically managed malignant bowel obstruction. To audit against six standards set following a literature review.
Method Retrospective, multi-centre review of case notes.
Results Thirteen organisations returned 101 data collection sheets (5 hospices 8 hospitals). Ninety-nine of these were used (41 from hospices and 58 from hospitals). The presence or absence of nausea, vomiting and colic was documented at initial assessment in 80%, 91%, 80% respectively (n=99). Antiemetics were prescribed via non-oral routes in patients with nausea and/or vomiting regularly in 90% (n=252) and PRN in 97% (n=236). Regular or continuous medications via non-oral routes were prescribed within 48 h of a documented episode of nausea and/or vomiting secondary to malignant bowel obstruction in 68%. Consideration was given to reviewing management of nausea and vomiting in patients requiring two or more PRN medications for nausea and vomiting in the preceding 24 h. Day 2 82% (n=22), Day 4 88% (n=19). Metoclopramide was stopped if colic was present in 27% (n=11). 6. The co-prescription of cyclizine and metoclopramide should not occur – regular 100% (n=99) Regular +PRN 93% (n=99)
Conclusion Regular assessment of symptoms is crucial in patients with medically managed bowel obstruction. Frequency and route of administration should be considered. Regular review is required to establish effectiveness of management and the need for change. PRN and regular medication combinations need assessment.
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