BACKGROUND/PURPOSE
Febrile neutropenia (FN) is considered a life-threatening oncologic emergency that requires prompt recognition of the condition and expeditious administration of antibiotics. In 2021, a neutropenic workgroup in the VA Northeast Ohio Healthcare System (VANEOHS) began working on updating the neutropenic policy to match current neutropenic guidelines. In 2022, the policy was approved, and the following changes were implemented (1) timing of antibiotic administration changed from two hours to one hour of fever presentation (2) absolute neutrophil count (ANC) criteria changed from an ANC of ≤ 1.0 K/cmm to an ANC of ≤ 0.5 K/cmm or an ANC that is expected to decrease to ≤ 0.5 K/cmm during the next 48 hours.
SYNTHESIS OF LITERATURE
Each hour that antibiotics are delayed is associated with a decrease in survival and an increase in mortality of 7.6% (Koenig et al, 2019).
INTERVENTIONS
The existing neutropenic policy, order sets, and antibiogram were updated. The physicians, pharmacists, and nurses from the neutropenic workgroup conducted educational in-services with their respective groups. Badge backers were created for inpatient nursing staff to wear as a quick reference. Posters were hung in the medicine team workrooms. A protected health information (PHI) Outlook email was set up to automatically generate, notifying workgroup members when initial antibiotics are administered to a patient with neutropenic fever. This email allows “real time” tracking of initial antibiotic administration. A certificate of recognition was created to email to nurses who administer antibiotics within the 1-hour timeframe.
RESULTS
Monthly chart audits of timing from fever presentation to antibiotic administration are conducted. Data is reported monthly at the neutropenic workgroup meetings. The following data was gathered after implementation and shows gram negative antibiotic administration within one hour of fever presentation: September 2022, 100% (n = 1), October 2022, 100% (n = 1), November 2022, N/A (n = 0), December 2022, N/A (n = 0), January 2023, N/A (n = 0), February 2023, 100% (n = 1), March 2023, 100% (n = 1), and April 2023, N/A (n = 0).
IMPLICATIONS
Continue to monitor data to ensure targets are met and reevaluate process as needed.