When do you consider scheduled antiemetics in hospitalized patients experiencing severe nausea?

The biggest problem I see is antiemetics given PRN when a patient has consistent nausea. The goal is to get above the nausea so that the patient begins to feel better. This is similar to how one treats pain.

Thus, if a patient is taking an antiemetic more than once a day and has consistent nausea, I start an around-the-clock antiemetic with one drug class and then leave another drug class as a PRN.

If that doesn't work, I'll give them 2 drug classes around the clock.

While prolonged T-intervals are an issue, I think in the short term it's uncommon. Thus, if pre-EKG does not show PRNQT, I may check an EKG a day or two after around-the-clock antiemetics, but will not put people on monitors and will not otherwise alter my plan.