Implementation of an Evidence-Based Order Set to Impact Initial Antibiotic Time Intervals in Adult Febrile Neutropenia

Best, Janie T.; Frith, Karen H.; Anderson, Faye; Rapp, Carla Gene; Rioux, Lisa; Ciccarello, Christina

doi:10.1188/11.onf.661-668

Cited by 26 publications

(22 citation statements)

References 27 publications

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“…The common reasons for delayed in assessment and antibiotic administration reported in literature are: Antibiotics are prescribed by doctors but their administration is delayed, prolonged time to assessment by the junior staff, lack of awareness of natural evolution of course of neutropenic sepsis, failure of the emergency department to stock the appropriate antimicrobial therapy, and lack of a distinct protocol for febrile neutropenia [8,9]. A significant decrease in time-to- antibiotic administration has been demonstrated when order sets were utilized to increase efficiency in antibiotic administration or when multiple ED initiatives were taken to improve patients triage [12-14]. …”

Section: Discussionmentioning

confidence: 99%

Time to antibiotics and outcomes in cancer patients with febrile neutropenia

Perron

Emara

Ahmed

2014

BMC Health Serv Res

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BackgroundFebrile neutropenia is an oncologic emergency. The timing of antibiotics administration in patients with febrile neutropenia may result in adverse outcomes. Our study aims to determine time-to- antibiotic administration in patients with febrile neutropenia, and its relationship with length of hospital stay, intensive care unit monitoring, and hospital mortality.MethodsThe study population was comprised of adult cancer patients with febrile neutropenia who were hospitalized, at a tertiary care hospital, between January 2010 and December 2011. Using Multination Association of Supportive Care in Cancer (MASCC) risk score, the study cohort was divided into high and low risk groups. A multivariate regression analysis was performed to assess relationship between time-to- antibiotic administration and various outcome variables.ResultsOne hundred and five eligible patients with median age of 60 years (range: 18–89) and M:F of 43:62 were identified. Thirty-seven (35%) patients were in MASCC high risk group. Median time-to- antibiotic administration was 2.5 hrs (range: 0.03-50) and median length of hospital stay was 6 days (range: 1–57). In the multivariate analysis time-to- antibiotic administration (regression coefficient [RC]: 0.31 days [95% CI: 0.13-0.48]), known source of fever (RC: 4.1 days [95% CI: 0.76-7.5]), and MASCC high risk group (RC: 4 days [95% CI: 1.1-7.0]) were significantly correlated with longer hospital stay. Of 105 patients, 5 (4.7%) died & or required ICU monitoring. In multivariate analysis no variables significantly correlated with mortality or ICU monitoring.ConclusionsOur study revealed that delay in antibiotics administration has been associated with a longer hospital stay.

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Section: Discussionmentioning

confidence: 99%

Time to antibiotics and outcomes in cancer patients with febrile neutropenia

Perron

Emara

Ahmed

2014

BMC Health Serv Res

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“…Limitations of the study included a retrospective design and comparison of patients managed in different level hospitals, university and community hospitals, with lack of standardisation for usual care. Best et al () conducted the same design study reviewing 30 FN patients managed without an order set (clinical guideline), comparing them to 23 patients treated with an order set. As with Lim et al’s study, Best et al demonstrated decreased time delays in AB administration when a FN protocol was followed ( t = 2.25; df = 37; p = 0.031).…”

Section: Resultsmentioning

confidence: 99%

“…Patients cared for by clinicians using the guidelines experienced decreased time delays in AB administration (3.9 versus 4.9 hr, p = 0.02). Limitations of the study included a ret rospective design and comparison of patients managed in different level hospitals, university and community hospitals, with lack of standardisation for usual care Best et al (2011). conducted the same design study reviewing 30 FN patients managed without an order set (clinical guideline), comparing them to 23 patients treated with an order set.…”

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confidence: 99%

Critical review of emergency department management of chemotherapy complications in cancer patients

Blanco

2018

Eur J Cancer Care

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Introduction Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy‐related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care. Methods This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines. Results The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross‐sectional case–control studies and randomised control trials. Conclusion All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.

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“…The importance of prompt reporting of fever should be emphasized for those subjects receiving myelosuppressive chemotherapy. According to Best et al .,[35] initiating antibiotic therapy in a timely manner is important to treat FN because the delay in treatment can increase the patient's risk for sepsis and death. In the study, 27% of the subjects did not know the temperature at which they should seek medical help.…”

Section: Discussionmentioning

confidence: 99%

Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

Mak

Ching

2015

Asia-Pacific Journal of Oncology Nursing

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Objective:To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen.Methods:Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist.Results:No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group (P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group (P = 0.009).Conclusions:The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN.

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Implementation of an Evidence-Based Order Set to Impact Initial Antibiotic Time Intervals in Adult Febrile Neutropenia

Cited by 26 publications

References 27 publications

Time to antibiotics and outcomes in cancer patients with febrile neutropenia

Time to antibiotics and outcomes in cancer patients with febrile neutropenia

Critical review of emergency department management of chemotherapy complications in cancer patients

Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

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