Implementation of the Baxter Animated Retching Faces Nausea Assessment Scale in Pediatric Oncology: A Quality Improvement Project.

Introduction: Chemotherapy-induced nausea in the pediatric oncology population can be uniquely challenging to assess and manage. Adequate assessment and documentation of a patient's nausea can be used to evaluate the efficacy of antiemetic interventions and to optimize patient management. This project aimed to introduce a pediatric nausea assessment tool and develop a standardized process to improve the frequency of nursing documentation of nausea. Methods: This single-institution quality improvement project utilized a stepwise process to introduce the Baxter Animated Retching Faces (BARF) scale as a new tool to the pediatric oncology unit, educated staff on the use of the tool, and ultimately facilitated documentation of BARF scales within the patient's electronic medical record. Plan-do-study-act methodology was used to evaluate the effectiveness of each incremental change. Results: The percentage of oncology patients with at least three documented nausea assessments on active chemotherapy days increased from 5% at baseline to 75% within the first month following implementation into the electronic medical record, peaked at 94% in September 2022, and remained above the project goal of 75% for two years after completion of the active project. Conclusions: The BARF scale was readily integrated into routine care in a pediatric oncology service. This documentation helped bridge the gap between bedside evaluations and treatment decisions, improving patient care.