Vomiting of oral medications by pediatric patients: Survey of medication re-dosing practices in pediatric oncology and stem cell transplant centers

IntroductionThere is limited guidance available to indicate next steps when a child vomits after taking an oral medication. Vomiting is a frequent problem in pediatric oncology.MethodsThe primary objective was to describe factors influencing healthcare practitioners' decisions to re-dose oral medications, including chemotherapy, after vomiting in pediatric oncology patients. The primary outcome was the proportion of respondents who list a factor influencing their decision as "very important". Secondary objectives were to describe protocols and practice. An online survey was distributed via email networks to approximately 3600 nurses and 1470 pharmacists at pediatric oncology and Stem Cell Transplant centers in North America. Survey responses were analyzed using descriptive statistics and content and thematic analyses for the open-ended questions.ResultsOf the 110 responses received, 87 were included. Response rate could not be calculated, which has implications for non-response bias. Participants reported patients vomiting after oral medication occurred either weekly (41%) or monthly (33%). Seventy-four participants indicated they followed a general rule for re-dosing oral chemotherapy medications after vomiting, with 62% indicating they would re-dose if vomiting occurred within 30 min of the dose. The most important factors impacting the decision to re-dose were time after dose ingestion (77%), type of medication (67%) and whether the medication is an investigational drug (54%). Twenty-four participants reported that their institute had a guideline to assist with making the decision to re-dose a medication after vomiting.ConclusionsThe problem of vomiting after the administration of an oral medication is prevalent; however, there are few guidelines available.