Reducing the Door to Needle Time for Antibiotics in Suspected Neutropenic Sepsis using a Dedicated Clinical Pathway

Williams, A.; Candish, C.; Ayrton, C.; Naylor, G. R. E.; Lam, Stefanie; Counsell, R.

doi:10.1016/j.clon.2014.04.003

Cited by 3 publications

(7 citation statements)

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“…Research on TTA with fever and neutropenia has demonstrated improved morbidity and mortality in those who experience RTTA on hospital presentation (Fletcher et al, 2013;Perron, Emara, & Ahmed, 2014). The available research supports that a delay (more than 60 minutes from presentation) in TTA is independently associated with adverse events including mortality, intensive care unit (ICU) admission, and hypotension requiring fluid administration (Fletcher et al, 2013;Lin, Weinstein, & Hota, 2008;Perron et al, 2014;Williams et al, 2014).…”

Section: Introductionmentioning

confidence: 95%

“…According to the American Childhood Cancer Organization (2014), approximately 13 400 American children aged birth to 19 years are diagnosed with cancer each year. The chemotherapy that many of these patients receive leads to neutropenia (Williams et al, 2014). Fever and neutropenia is considered a life-threatening, medical emergency and a leading cause of morbidity and mortality among pediatric cancer patients (Hakim & Gaur, 2011; Volpe et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Numerous investigators have demonstrated the efficacy of RTTA in vulnerable populations (Fletcher et al, 2013; Lin et al, 2008; Perron et al, 2014; Williams et al, 2014). Several studies that specifically involve neutropenic patients support the benefit of RTTA.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies that specifically involve neutropenic patients support the benefit of RTTA. The most applicable are those that involve the treatment of cancer patients with neutropenia with suspected or known infection (Fletcher et al, 2013; Lin et al, 2008; Perron et al, 2014; Williams et al, 2014). RTTA in neutropenic pediatric patients with known or suspected infection is associated with improved outcomes (Fletcher et al, 2013; Williams et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a Pathway for the Treatment of Fever and Neutropenia in Pediatric Patients With Cancer

Vanderway

Vincent

Walsh

et al. 2017

J Pediatr Oncol Nurs

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Fever and neutropenia is an oncologic emergency. Time-to-antibiotics (TTA) refers to the amount of time from initial provider evaluation for fever and neutropenia to intravenous antibiotic administration. Research supports that rapid time-to-antibiotics (RTTA) is associated with improved patient outcomes. This quality improvement project evaluated the success of implementing an RTTA pathway in pediatric oncology patients with fever and neutropenia. The setting was an advanced practice nurse-managed pediatric ambulatory infusion center where patients with fever and neutropenia were often evaluated and treated. In order to improve TTA, a multidisciplinary pathway was implemented with a goal of TTA that was less than 60 minutes from initial provider evaluation. Implementation of the RTTA pathway included discussion of shared expectations with the pharmacy and education departments and discussion of shared expectations with the bedside nurses and advanced practice nurses staffing the unit. Additionally, a preliminary lab test was utilized. Success of the implementation was evaluated through 2 measures: TTA and nurses' knowledge of fever and neutropenia and the importance of RTTA. The aims of this project were to improve TTA as well as nurses' knowledge of fever and neutropenia and the importance of RTTA, and both these aims were successfully attained.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Implementation of a Pathway for the Treatment of Fever and Neutropenia in Pediatric Patients With Cancer

Vanderway

Vincent

Walsh

et al. 2017

J Pediatr Oncol Nurs

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“…Williams (2014) described a number of interventions introduced in Cheltenham General Hospital Oncology centre, including a multidisciplinary clinical pathway and education programme based on the sepsis six care bundle and a patient group direction for nurse led initiation of antibiotics. 7 They reported only 32% of 26 patients over a 2 week baseline audit received antibiotics within one hour, which improved to 97% over a 2 week reaudit following implementation of their changes.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

Chasing the Golden Hour – Lessons learned from improving initial neutropenic sepsis management.

Forde

Scullin

2017

BMJ Qual Improv Report

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Neutropenic sepsis remains a time critical and potentially fatal complication of systemic anti-cancer therapy. A target ‘door to needle’ time of one hour for first dose empirical intravenous antibiotics continues to be promoted nationally. A baseline audit (June 2011) highlighted shortfalls in care in the Belfast Trust, with only 15% of patients receiving antibiotics within sixty minutes. A multi-professional group within the Trust was established to try and initiate the improvements in neutropenic sepsis recognition and initial management that were urgently required. A number of strategies have been developed over the last five years. Firstly an integrated care pathway was introduced, which is currently used by nursing and medical staff for patients presenting with suspected neutropenic sepsis, through acute cancer centre assessment areas and emergency departments, as well as inpatients developing neutropenic sepsis. An initial reaudit June 2012 demonstrated improvement (62% meeting 1hour target), but a subsequent audit, January 2013, was disappointing (only 50% meeting 1hour target). In response, a new compact, user-friendly care pathway was introduced. A range of other measures have also been subsequently introduced. Patients' care is continually monitored through simple ward based documentation, completed after initial treatment of each neutropenic sepsis episode. A patient group direction facilitates nurse led prescribing and administration of first dose antibiotics. Regular multidisciplinary education sessions and improved access to regional guidelines have also been prioritised. From November 2013, consistently greater than 80% of patients have met the one hour target. Recent data continues to be encouraging; in July 2016 100% of patients received first doses within sixty minutes, in October 95% of patients. Significant sustained improvements in meeting the sixty minute target have been demonstrated. The combination of measures ensures neutropenic sepsis is considered and basic clinical care delivered quickly and safely, through a co-ordinated standardised approach, to avoid complications.

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Improving door-to-needle times for patients with suspected neutropenic sepsis

Wild

2017

Emergency Nurse

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Neutropenic sepsis is a potentially life-threatening complication of chemotherapy and has an associated mortality of 2% to 21%. Patients can deteriorate rapidly and are usually advised to attend their local emergency department (ED) for urgent assessment and antibiotic therapy within one hour of arrival. Delivery of this emergency care is, however, inconsistent, and at times suboptimal, due to a lack of awareness of the condition and of clinical expertise. This article discusses a collaborative project between an acute oncology service and an ED, which has improved and sustained compliance with this standard through a range of initiatives, including revised and integrated sepsis guidelines, education, sepsis champions and a fast-track patient pathway. A transformational leadership approach, which embraced collaborative working and fostered motivation by creating ownership of the project by the ED team, has been instrumental in its success.

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Reducing the Door to Needle Time for Antibiotics in Suspected Neutropenic Sepsis using a Dedicated Clinical Pathway

Cited by 3 publications

References 0 publications

Implementation of a Pathway for the Treatment of Fever and Neutropenia in Pediatric Patients With Cancer

Implementation of a Pathway for the Treatment of Fever and Neutropenia in Pediatric Patients With Cancer

Chasing the Golden Hour – Lessons learned from improving initial neutropenic sepsis management.

Improving door-to-needle times for patients with suspected neutropenic sepsis

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