Use of clinical pictures in the management of nausea and vomiting: a prospective audit

Abstract

This prospective audit aimed to evaluate a guideline for the management of nausea and vomiting in palliative care inpatients. Clinical pictures were used to guide diagnosis and treatment, with potentially reversible causes being addressed where appropriate. Over a 3-month period, 40 patient episodes occurred, all of which were included in the audit. The commonest clinical pictures were gastric stasis/outlet obstruction (35%) and chemical/metabolic (30%). Management according to the guideline was effective. Nausea was abolished in 28 of 34 cases (82%) and vomiting resolved completely in 26 of 31 cases (84%). Symptoms were totally controlled in a mean time of 3.4 days.

Nausea and vomiting, although distressing symptoms, can be controlled in the majority of cases. Multi-centre prospective audit, using a standardized tool, may prove useful in allowing larger numbers of patients to be systematically analysed and individual centres to compare outcomes.

Keywords

audit antiemetics nausea neoplasms palliative treatment vomiting

Get full access to this article

View all access options for this article.

References

Allan S . Nausea and vomiting. In: Doyle D , Hanks GW , McDonald N eds. Oxford textbook of palliative medicine, 2nd edition. Oxford: Oxford Medical Publications, 1998: 282–289.

Twycross R . Alimentary symptoms. In: Twycross R ed. Symptom management in advanced cancer, 2nd edition. Oxford: Radcliffe Medical Press, 1997: 188–198.

Twycross R , Black I . Nausea and vomiting in advanced cancer. Eur J Palliat Care 1998; 5: 39–45.

Twycross R . The use of prokinetic drugs in palliative care. Eur J Palliat Care 1995; 2: 143–145.

Baines MJ . Nausea, vomiting, and intestinal obstruction. Br Med J 1997; 315: 1148–1150.

Lichter I . Palliation of nausea and vomiting. Prog Palliat Care 1994; 2: 177–181.

Lichter I . Which antiemetic? J Palliat Care 1993; 9(1): 42–50.

Twycross R , Barkby G , Hallwood P . The use of low dose levomepromazine (methotrimeprazine) in the management of nausea and vomiting. Prog Palliat Care 1997;5: 49–53.

Lichter I . Results of antiemetic management in terminal illness. J Palliat Care 1993; 9(2); 19–21.