Congress Abstracts 2006

122

DEVELOPMENT OF A FEBRILE NEUTROPENIC PATHWAY. Lynne Brophy, RN, MSN, OCN^®, AOCN^®, Bethesda North Hospital-TriHealth, Cincinnati, OH; Sharon Hafertepe, RN, MSN, Good Samaritan Hospital-TriHealth, Cincinnati, OH; Teresa Lippert, RN, Bethesda North Hospital-TriHealth, Cincinnati, OH; and Sara Godfrey, RN, BSN, OCN^®, and Pat Berning, RN, OCN^®, Good Samaritan Hospital-TriHealth, Cincinnati, OH.

Neutropenic sepsis is a major cause of death in patients receiving cancer therapy. Through assessment and education, nurses can decrease the risk of death from sepsis. Delays were noted in quick identification and treatment of patients with of febrile neutropenia.

1. Increase and facilitate identification and treatment of neutropenia related sepsis.
2. Initiate antibiotic treatment within two hours of admission to the Emergency Department
3. Reduce the number of ICU admissions for neutropenic patients admitted through the Emergency Department.
4. Improve communication between the Emergency Department, inpatient medical units and medical staff.
5. Standardize care delivery by developing admission orders and a clinical pathway.

1. Examined the current evidence regarding care of neutropenic patients and then weighed findings against patient values and the clinical population in our area.
2. Developed an outcome based multidisciplinary clinical pathway and admission orders incorporating established Tri-Health fever and Neutropenic precautions that have reduced infection rates and costs of care in our leukemic population.
3. Aligned Emergency Department's triage orders for neutropenic patients.
4. Educated Emergency Department, inpatient nursing and medical staff about identification of neutropenic sepsis and use of the pathway.
5. Developed a wallet identification card for patients who are at risk for neutropenia. Patients are given this card in physician's offices and oncology clinics and asked to present it to the triage nurse in the emergency department upon arrival.
6. Developed Patient education tools, including discharge instructions, mouth care, and identification of signs and symptoms of infection.

1. Length of time between presentation to the Emergency department and initiation of antibiotics.
2. Number of patients who presented their wallet identification cards.
3. Number of patients who were admitted to ICU with neutropenic sepsis.
4. Length of stay of the patients who entered the hospital through the emergency department that were placed on the pathway with the order set compared to those who were not.

The impact of pathway use on nursing practice and LOS will be discussed.