Improving Time to Antibiotics for Pediatric Oncology Patients With Fever & Suspected Neutropenia

Key Points:

• Fever in the setting of neutropenia is a potentially life threatening complication of cancer treatment.

• A time of less than 60 minutes from presentation to antibiotic administration is therefore recommended (Geerlinks et al., 2020).

• Guidelines for the management of patients who present with chemotherapy-associated febrile neutropenia (FN) recommend the administration of broad spectrum antibiotics within 60 minutes after triage to reduce the possibility of complicated infections.

• Delays in time to antibiotics (TTA) are associated with an increase in adverse events including longer hospital stays, increased admissions to the intensive care unit, and higher mortality rates, in both adult and pediatric settings (Geerlinks et al., 2020).

• TTA within 60 minutes is identified as an important quality indicator.

Barriers Vs. Solutions

1. Barrier- Waiting in waiting room for registration; Solution- Clerk to register pt. in pts room using medical workstation with portable computer

2. Barrier- Waiting for laboratory personnel to collect capillary blood sample for CBC; Solution- Nurse to access CVAD (Central Venous Access Device) and collect required blood samples for CBC immediately after patient was placed in the room.

3. Barrier- Waiting for application of topical anesthetic; Solution- Instruct family to apply topical anesthetic on route to ED line. If patient/ family forgets to apply topical anesthetic, nurse to access port in absence of topical anesthetic application (Geerlinks et al., 2020).

**Full list can be found at the referenced listing.

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Key Terms:

Neutropenia- the presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection. It is an undesirable side effect of some cancer treatments.

Febrile Neutropenia (FN)- is the development of fever, often with other signs of infection, in a patient with neutropenia, an abnormally low number of neutrophil granulocytes (a type of white blood cell) in the blood.

Central Venous Access Device (CVAD)-a broad term that includes many types of catheters (thin, flexible hollow tubes) that are inserted into and positioned within a vein in the body to deliver therapies to the bloodstream.

Reference:

Kram, D. E., Salafian, K., Reel, S. M., Johnson, E. N., Borsheim, B., Russell, T. B., Pearsall, W. A., Mitchell, M., & McCalla, C. (2020). A quality improvement initiative: Improving time-to-antibiotics for pediatric oncology patients with fever and Suspected Neutropenia. Pediatric Emergency Care, 36(11), 509–514. https://doi.org/10.1101/2020.11.25.20233205