Optimizing Time to Antibiotic Administration in Children with Possible Febrile Neutropenia through Quality Improvement Methodologies

Abstract

Introduction: Febrile neutropenia is a potentially life-threatening complication of chemotherapy in pediatric oncology patients. Prompt initiation of antibiotic therapy may minimize morbidity and mortality associated with this condition, and time to antibiotic (TTA) administration <60 minutes is used as a quality benchmark by many institutions. We implemented a quality improvement initiative to achieve TTA < 60 minutes in >80% of eligible patients in the pediatric emergency department. Methods: After collecting baseline data, we employed consecutive PDSA cycles to (i) reduce time to antibiotic order after patient arrival; (ii) expedite the preparation of antibiotic by pharmacy; and (iii) enable antibiotic ordering before patient arrival. Statistical process control methodologies were used for key outcome measures to compare pre-intervention, post-intervention, and maintenance periods. Results: Comparing pre-intervention and post-intervention years, mean TTA decreased from 64 to 53 minutes and the percentage of patients receiving antibiotics in <60 minutes increased from 59% to 84%. Improvements were sustained in the maintenance period of the project, with mean TTA administration of 44 minutes and 85% of patients receiving antibiotics within our stated goal. Conclusion: Through a series of PDSA cycles, we decreased TTA and increased the percentage of febrile neutropenia patients receiving antibiotics in <60 minutes.

Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents

“…In accordance with local and state-based clinical guidelines, most children (60%) received antibiotics within one hour of hospital presentation [16] . Overall, the mean LOS was 8.7 (SD = 11.5) days and children typically received antibiotics for 7 days (mean = 7.3; SD = 7.8).…”

“…We present results for HRQoL over an acute period (0À7 days after FN onset) and after the resolution of the FN episode (7À30 days after FN onset). This 30day follow-up period reflects the expected period for resolution and recovery from an FN event [16]. However, as we are the first study to examine the HRQoL of children with cancer using the CHU9D, it was not possible to determine whether children in our study fully recovered from their FN episode at 30-days follow-up by benchmarking against other CHU9D results from other studies in which children were not experiencing FN.…”

Time to antibiotics (TTA) in paediatric patients with fever in the setting of neutropenia

“…2 Febrile neutropenia is a common and life-threatening complication in paediatric cancer patients on chemotherapy. 3,4 It is characterised by fever (temperature ≥38.3°C (101°F) or ≥38°C (100.4°F) for at least 1 hour). 2 Bacterial infection facilitated by immunosuppression is the vital cause of mortality and morbidity in cancer patients.…”

“…5 Morbidity and mortality correlated with this situation can be minimised if the clinicians initiate antibiotic treatment expeditiously. 3 It has been established that the administration of antibiotics in patients presenting with febrile neutropenia in <60 minutes of arrival in the emergency room (EAR) can significantly reduce mortality and morbidity. 6 This study aimed to ensure timely administration of antibiotics (in <60 minutes) in paediatric oncology patients presenting to the EAR with fever following chemotherapy.…”

Improving Timely Antibiotic Administration for Pediatric Oncology Patients With Neutropenic Fever Seen in the Emergency Department

“…Other institutions have used quality improvement methods to reduce the door-to-antibiotic time for this patient population with varying degrees of success and sustainment. 6 , 7 , 8 Initiatives at each institution vary based on local resources, interdepartmental relationships, and the unique findings of each gap analysis and root cause process.…”