A Quality Improvement Initiative to Reduce Time to Antibiotics in Oncologic Neutropenic Fever

Introduction: This paper documents a Quality Improvement (QI) initiative using Plan-Do-Study-Act (PDSA) cycles to decrease time to antibiotics (TTA) in oncologic neutropenic fever (NF) patients in a large tertiary-care academic medical center to the national guideline target of 60 minutes. Methods: We measured baseline NF TTA across hospital units in the summer of 2018 and analyzed factors underlying delays in antibiotic treatment. We then developed a multi-disciplinary team to implement four proposed interventions: Ensure that oncology floors are appropriately stocked with antibiotics required for initial NF treatment Implement a nursing based order set for treatment of new NF cases. Develop revised guidelines for treatment of oncologic NF Create and disseminate educational materials for house staff about treatment of NF. NF TTA was measured after implementation of each intervention and stakeholder groups were held to assess challenges and successes with each intervention. Following this, interventions would be continued, revised, or abandoned. Results: Results from pilot implementation of interventions 1 & 3 showed a decrease in median TTA to 73 minutes compared to 117.5 minutes in the baseline period. Based on these results, interventions 1 and 3 were adopted as standard practice in summer 2019 and 4 was implemented in December 2019. Conclusion: This study shows the utility of the PDSA cycle approach in implementing initiatives designed to improve time sensitive aspects of hospital care. Ongoing efforts are needed to meet national guidelines with a goal TTA of 60 minutes. We feel our methodology is reproducible for similar problems in other fields of medicine and flexible enough to be scalable to other institutions

Reducing Time to Antibiotics in Patients with Neutropenic Fever on a Bone Marrow Transplant Unit

Background/Methods: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes. Methods: Chart reviews were performed to identify causes for delays in antibiotics (abx). Based on a root cause analysis, 4 interventions were implemented: cefepime was stocked in the pyxis (Int 1 – August 2018), NF guidelines were updated (Int 2 – October 2019), educational videos were created for just in time learning for house staff rotating on the oncology services and an education campaign for the nursing staff (Int 3 – June 2020), a nurse driven protocol to release and administer abx was piloted on the BMT (Int 4 – December 2021)

A QI Initiative to Reduce Time to Antibiotics in Oncologic Neutropenic Fever

Problem Statement Neutropenic fever (NF) (defined as temperature of 101o F on one occasion, or 100.4o F sustained over 60 minutes in a patient with an absolute neutrophil count (ANC) less than 500, or suspected drop below 500 within 48 hours) is relatively common oncologic emergency, particularly in hematologic malignancy patients. Expert consensus is that anti-pseudomonas gram-negative antibiotics (abx) should be administered within 60 minutes of detecting neutropenic fever. At Thomas Jefferson University Hospital (TJUH), internal guidelines for time to treatment in neutropenic fever are in line with expert consensus - 60 minutes. We found that from July 1st – November 21st, 2018 our median time to abx in neutropenic fever cases was 117.5 minutes. As a result we are proposing to implement a continuous process improvement initiative using PDSA (Plan-Do-Study-Act) cycles with the goal of reducing time to treatment for neutropenic fever.https://jdc.jefferson.edu/patientsafetyposters/1121/thumbnail.jp