Scientific Poster Session IV: Students Research-in-Progress

Abstract

Fosaprepitant is approved prophylactically for chemotherapy-induced nausea and vomiting (CINV) due to moderately or highly emetogenic regimens. Recent studies support the use of fosaprepitant to prevent post-operative nausea and vomiting (PONV). Fosaprepitant at Mayo Clinic Arizona is limited to the perioperative and hematology/oncology settings. The purpose of this study was to assess the use of fosaprepitant at Mayo Clinic Arizona.

Research Question or Hypothesis:

Review the utilization, compounding, and waste of fosaprepitant at an academic medical center. Identify opportunities to improve institutional use and process.

Study Design:

A retrospective chart review was completed for fosaprepitant administrations between January 1 and July 31, 2023.

Methods:

A retrospective chart review to evaluate fosaprepitant administrations from January 1 through July 31, 2023. Only the first administrations were reviewed. Orders associated with a treatment or therapy plan were excluded. Pharmacy compounding volumes were also reviewed.

Results:

A total of 192 fosaprepitant administrations were included. Three or more antiemetics were administered within 24 hours prior to fosaprepitant for 90% of patients with ondansetron, dexamethasone, and prochlorperazine being the most common. A prolonged QTc, defined as = 500 ms was discovered in 11% of all administrations. After assessing compounding and waste records, 21% of compounded products were wasted. In addition to labor, this waste equates to a loss of $3,633 for the product alone. Surgical teams were the highest prescribers, followed by internal medicine and critical care.

Conclusion:

This evaluation discovered that of the administrations for off-label use, the majority of fosaprepitant administrations were preceded by another antiemetic, with 38% utilizing three or more agents suggesting refractory nausea and vomiting requiring escalation. Current waste suggests there is an opportunity to improve compounding and storage practice. Providers primarily using fosaprepitant adheres to restriction criteria, however, use by additional specialties presents an opportunity for future research.

Presenting Author

Authors