Improving Time to Antibiotic Administration for Bone Marrow Transplant Patients With First Fever

Daniels, Paulina; Pate, Abigail; Flesch, Laura; Teusink‐Cross, Ashley; Matani, Hirsch; Geiger, A.; Hayward, Melissa; Myers, William G.; Schaefer, Samantha; Nelson, Adam; Jodele, Sonata; Davies, Stella M.; Dandoy, Christopher E.

doi:10.1542/peds.2017-1549

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…There are several publications on the standardization of timely antibiotic administration in pediatric immunocompromised patients in the emergency room 14-16 or inpatient settings 9,10 using QI methodology. One recent study from a large children's hospital showed improvement from 35% to 65% for patients receiving antibiotics within 60 minutes of fever if there was a fever contingency plan in the daily progress note.…”

Section: Discussionmentioning

confidence: 99%

“…9 Another large children's hospital study reported sustained improvement in administration of antibiotics >90% of the time at their bone marrow transplantation unit. 10 Interventions that led to improvement were establishing standardized processes for provider notification and timely antibiotic ordering, and prioritization of antibiotic preparation at the pharmacy. These processes were less important at our center.…”

Section: Discussionmentioning

confidence: 99%

“…Two single-institution studies demonstrated sustained improvements in the percentage of patients receiving antibiotics in <60 minutes using quality improvement (QI) methodology. 9,10 By using several universal QI tools, including process flow, key driver, and cause and effect diagrams, we hypothesized that lack of awareness of the 60-minute mark, ineffective streamlining of the multiple processes involved between a fever and antibiotic administration are main reasons for the delays. We designed interventions by team consensus addressing these possible barriers to achieve the following goal: to increase the percentage of inpatient oncology patients receiving antibiotics in <60 minutes of a new fever to >90% by January 2023 (SMART Aim).…”

Section: Introductionmentioning

confidence: 99%

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Improving Time to Antibiotic Administration for Pediatric Oncology Patients With New-Onset Fever

Smith,

Read,

Agarwal

et al. 2024

JCO Oncol Pract

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PURPOSE Time to antibiotic administration (TTA) in <60 minutes for children with neutropenic fever presenting to an emergency room is associated with reduced incidence of sepsis and intensive care admission. As such, TTA is used as a national quality metric for pediatric oncology patients. At our center, in 2020, 19% of the hospitalized patients with a new fever encounter were receiving antibiotics in <60 minutes, prompting a multidisciplinary approach to reach a goal of >90% in all pediatric patients with cancer with a new fever. METHODS A multidisciplinary team completed four Plan-Do-Study-Act cycles between March 2021 and September 2023. We implemented education initiatives, an updated handoff smartphrase guiding the on-call team, an antibiotic champion (AC) nursing role, a revised fever plan for handoff, a rapid-response team to address new fevers, and an algorithm for blood culture collection. Data were collected, analyzed, and reported biweekly with feedback sought for delays in TTA. RESULTS There was a total of 639 new fevers in 329 unique oncology patients. As of September 4, 2023, average TTA decreased from 89 minutes at baseline to 46.4 minutes for more than 12 months. The percentage of patients receiving first dose of antibiotic in <60 minutes also increased from 19% to 93.7%, which was sustained as well. The most effective interventions were creation of the AC role and streamlining the blood culture collection process. CONCLUSION This project demonstrates the importance of multidisciplinary involvement for providing optimal care. Specific implementation of targeted education, an AC role, and development of an algorithm streamlining the processes led to meaningful targeted improvements. Further analyses will explore the impact of these interventions on patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving Time to Antibiotic Administration for Pediatric Oncology Patients With New-Onset Fever

Smith,

Read,

Agarwal

et al. 2024

JCO Oncol Pract

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Critical Care Nursing of Haematopoietic Stem Cell Transplantation Patients

Botti

Seligardi

2023

Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation

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A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses’ activities in daily practice regarding antibiotic use

Bos,

Schouten,

De Bot

et al. 2023

JAC-Antimicrobial Resistance

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Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses’ activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses’ activities. Conclusions Nurses’ activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.

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Improving Time to Antibiotic Administration for Bone Marrow Transplant Patients With First Fever

Cited by 5 publications

References 26 publications

Improving Time to Antibiotic Administration for Pediatric Oncology Patients With New-Onset Fever

Improving Time to Antibiotic Administration for Pediatric Oncology Patients With New-Onset Fever

Critical Care Nursing of Haematopoietic Stem Cell Transplantation Patients

A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses’ activities in daily practice regarding antibiotic use

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