Open AccessOptimizing Time to Antibiotic Administration in Children with Possible Febrile Neutropenia through Quality Improvement Methodologies
Author(s) -
Beech Burns,
Melinda Hartenstein,
Amber Lin,
Denise Langley,
Erin Burns,
James Heilman,
Mary Tanski,
Linda C. Stork,
Oommen John
Publication year - 2019
Publication title -
pediatric quality and safety
Language(s) - English
Resource type - Journals
ISSN - 2472-0054
DOI - 10.1097/pq9.0000000000000236
Subject(s) - medicine , antibiotics , febrile neutropenia , pdca , neutropenia , emergency department , quality management , pharmacy , emergency medicine , intensive care medicine , pediatrics , chemotherapy , nursing , management system , management , economics , microbiology and biotechnology , biology
Febrile neutropenia is a potentially life-threatening complication of chemotherapy in pediatric oncology patients. Prompt initiation of antibiotic therapy may minimize morbidity and mortality associated with this condition, and time to antibiotic (TTA) administration <60 minutes is used as a quality benchmark by many institutions. We implemented a quality improvement initiative to achieve TTA < 60 minutes in >80% of eligible patients in the pediatric emergency department. Methods: After collecting baseline data, we employed consecutive PDSA cycles to (i) reduce time to antibiotic order after patient arrival; (ii) expedite the preparation of antibiotic by pharmacy; and (iii) enable antibiotic ordering before patient arrival. Statistical process control methodologies were used for key outcome measures to compare pre-intervention, post-intervention, and maintenance periods. Results: Comparing pre-intervention and post-intervention years, mean TTA decreased from 64 to 53 minutes and the percentage of patients receiving antibiotics in <60 minutes increased from 59% to 84%. Improvements were sustained in the maintenance period of the project, with mean TTA administration of 44 minutes and 85% of patients receiving antibiotics within our stated goal. Conclusion: Through a series of PDSA cycles, we decreased TTA and increased the percentage of febrile neutropenia patients receiving antibiotics in <60 minutes.