Improving Timely Antibiotic Administration in Patients With Febrile Neutropenia

Although the Infectious Disease Society of America recommends antibiotics be administered within 2 hours for patients with febrile neutropenia, the University of Illinois recognized that it did not have a standard process to ensure timely antibiotic administration for these patients.

Researchers from the university presented at a meeting held by the American Society of Clinical Oncology (ASCO) a new process to identify febrile neutropenic patients and implement an interventional strategy in the ambulatory setting. The abstract was presented at the 2017 ASCO Quality Care Symposium.

A chart review had found that of the 40 patients who were diagnosed with neutropenia in a 10-week period, 6 had febrile neutropenia and only 3 of them received antibiotics within the 2-hour time frame.

“We aimed to increase the percentage of febrile neutropenic patients receiving antibiotics within 2 hours from 50% to 100% in 8 weeks,” wrote the authors.

Internally, the university had brainstormed potential causes of delay in antibiotic initiation and developed a standard operative protocol that used an electronic provider-generated neutropenia checklist. The checklist would trigger actions to take and a standardized order set, such as STAT cultures and STAT antibiotics.

The new standard operative protocol will be piloted in 4 ambulatory settings for 8 weeks beginning in November. They will analyze time from event to antibiotic order, time from antibiotic order to administration, and compliance with high-risk neutropenic checklist.

A limited pilot had already found that following the template improved time to antibiotic administration to an average of 75 minutes.

The ideal process map included what to do if the patient was identified as being neutropenic but was no longer in the clinic, such as a phone call assessment with a doctor or a registered nurse, and how to proceed if the patient is still in the clinic and a check of vital signs reveals a fever or abnormal vitals.

“Although febrile neutropenia is a recognized medical emergency with clear guidelines on treatment, not all patients may receive antibiotics within the appropriate time frame,” the authors concluded. “It is therefore imperative for institutions to be aware of their level of IDSA compliance and implement appropriate quality improvements as required.”