Antibiotics in 30 Minutes or Less for Febrile Neutropenic Patients: A Quality Control Measure in a New Hospital

Abstract

Infections are the most common complication in patients receiving treatment for cancer with neutropenia being the primary risk factor for the development of an infection. In the neutropenic patient, bacteremia remains a significant cause of mortality. Although the literature reports that prompt empiric antibiotic therapy to prevent death caused by virulent organisms is the standard of care, the literature fails to identify what prompt antibiotic administration means. Door/fever-to-patient antibiotic delivery was evaluated as a quality control measure in a new children's hospital. Initially, door/fever-to-patient time was significantly delayed. Collaboration between pharmacy, hospital bed control, medical, and nursing staff resulted in many changes in practice by all groups. As a result, the goal for prompt antibiotic delivery of thirty minutes or less is now achievable.

Cohort Study of the Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia

“…This finding underscores the importance of validated institutional strategies focused on reducing any delay in starting antimicrobial treatment for neutropenic cancer patients (16)(17)(18).…”

Identification of educational and infrastructural barriers to prompt antibiotic delivery in febrile neutropenia: A quality improvement initiative

“…One study conducted among adult oncology patients found a median time of 210 minutes between presentation and antibiotic administration; interestingly, patients with more co-morbidities had longer delays [4]. In the pediatric setting, Corey and Snyder [5] found that average waiting times for antibiotics ranged from 80 to 120 minutes; no one met their aggressive target of 30 minutes. Through various multi-disciplinary educational initiatives, they were able to decrease average wait times to 25 minutes, with 80-100% of patients meeting the 30-minute target.…”

“…The most recent guidelines published by the Infectious Diseases Society of America briefly cite administration within 2 hours of presentation as ideal, but do not discuss this in detail [3]. While evidence is lacking to support a particular target, some institutions have implemented a target as low as 30-60 minutes from arrival [4,5].…”

A comparison of ED and direct admission care of cancer patients with febrile neutropenia

“…Another study of adult oncologic patients with febrile neutropenia identified several areas where ED care of this population can be improved logistically [5]. Institutions have developed and published quality improvement measures to decrease wait times to antibiotic administration in febrile neutropenia patients presenting through the ED [6][7][8]. However, it is unclear whether the quality of care provided to adult febrile neutropenia patients through the alternative pathway of direct hospital …”