Congress Abstracts 2004

54

REDUCING TIME TO ANTIBIOTICS IN CHILDREN WITH FEVER AND NEUTROPENIA PRESENTING TO THE EMERGENCY DEPARTMENT. Anne Senner, RN, MS, Kylie Stark, Tori Pennington, BMed, Lucy Maurice, RN, MN, Matthew O. Meara, MBBS, FRACP, and Richard J. Cohn, MBBCh, FCP(SA), FRACP, Sydney Children’s Hospital, Randwick, NSW.

The role of the clinical initiative nurse in the emergency department significantly reduced the time to first dose antibiotic in this pediatric oncology population.

For children with cancer, treatment-related neutropenia with associated fever is a potentially life threatening condition. Optimal management of these children requires prompt assessment and rapid initiation of the appropriate antibiotic therapy. Delay in commencing therapy may lead to an increase in morbidity and mortality. Consensus opinion advocates the commencement of antibiotic therapy within 60 minutes of presentation. The practice at Sydney Children’s Hospital is that all children who present with fever and possible neutropenia are triaged and clinically managed in the emergency department (ED). The ED investigated time to antibiotic in this patient population and the baseline data confirmed a potentially detrimental delay in administration of intravenous antibiotics. We will review ED practice and describe the subsequent use of the clinical practice improvement model to develop and evaluate a sustained improvement in patient care. The aim of this collaborative project between the ED and the Centre for Children’s Cancer and Blood Disorders (CCC&BD) was to have all children who present with fever and suspected neutropenia receive their first dose of intravenous antibiotics within 60 minutes of presentation to the ED.

The role of the clinical initiatives nurse was the key component of the new practice that led to the rapid assessment and management of these patients. The clinical initiatives nurse after triage identified the patient as requiring rapid nursing assessment and intervention. The nurse then initiated the ED’s treatment algorithm for children who present with fever with suspected neutropenia to allow for more rapid initiation of intravenous antibiotics after medical.

To study the effect of the practice change, a medical records audit of all children who presented to the ED with fever and neutropenia for the three-month period (2003) after implementation of the new practice was compared to the corresponding period in 2002. The average time taken from presentation to the ED to the administration of intravenous antibiotics was 76 minutes in 2003, compared to 177 minutes in 2002. There was an average improvement of 80 minutes to time to first dose of antibiotics. In the post-implementation treatment group, 16 out of the 20 children received antibiotics within 90 minutes of presentation.

This quality improvement project has resulted in a dramatic reduction in time from presentation to first dose of intravenous antibiotics in patients with fever and neutropenia and enhanced the collaborative practice between the ED and CCC & BD teams. The role of the clinical initiatives nurse was vital to the improvement in time to first dose of antibiotics.