Improving Door-to-Antibiotic Administration Time in Patients With Fever and Suspected Chemotherapy-Induced Neutropenia: A Tertiary Care Center Experience

Abstract

Background: Chemotherapy-induced febrile neutropenia (FN) is a major cause of morbidity and mortality in cancer patients if not treated promptly. As we were facing considerable delays in the management of chemotherapy-induced febrile neutropenic patients in the Emergency Department (ED), we initiated an improvement project aiming for “door-to-antibiotic time” of 60 minutes or less for all patients with fever and suspected chemotherapy-induced neutropenia. Methods: A multidisciplinary team was established to work on the project. We used quality improvement tools for mapping the existing patient flow processes of patients with FN in the ED. Several proposed change ideas have been tested using the Model for Improvement. These change ideas include improving the triaging process, creating an electronic “chemotherapy alert caution” and order sets for physicians, and using the hot-line by nurses to call the pharmacy to expedite the process of preparation of antibiotics. Outcome and process measures were collected weekly and they were discussed thoroughly and analyzed by the team. Run charts were used to monitor the progress. Results: After six Plan-Do-Study-Act cycles, all process measures improved and ultimately the “door-to-antibiotic time” was achieved by reducing it from 255 minutes to 49 minutes. During project testing and implementation, the nursing staff skills improvement and education were taken into consideration as a balancing measure. Conclusion: In a six-month period, the project led to a timely administration of antibiotics for patients with FN in the ED. This improvement was sustained for more than two years after the project initiation.

Keywords

• induced febrile neutropenia
• patient safety
• compliance
• antibiotic time
• triage
• emergency