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Implementation of a Nursing Based Order Set: Improved Antibiotic Administration Times for Pediatric ED Patients with

Tana Lukes1, Katharine Schjodt1, Leeza Struwe2

  • 1Children's Hospital and Medical Center, Omaha, NE, United States of America.

Journal of Pediatric Nursing
|March 12, 2019
PubMed

Insights

Delays in antibiotic administration for pediatric patients with chemotherapy-induced neutropenia and fever were significantly reduced. Implementing an evidence-based nursing order set improved time to antibiotics (TTA) to 53 minutes.

Area of Science:

  • Pediatric Emergency Medicine
  • Quality Improvement Science
  • Oncology Supportive Care

Background:

  • Delayed antibiotic administration in pediatric patients with chemotherapy-induced neutropenia and fever is linked to adverse outcomes.
  • Prompt treatment is crucial to prevent complications like ICU admission.

Purpose of the Study:

  • To reduce the time from triage initiation to antibiotic administration for pediatric emergency department patients with chemotherapy-induced neutropenia and fever.
  • Establish an evidence-based goal of 60-minute time to antibiotics (TTA).

Main Methods:

  • A quality improvement project utilized the Plan-Do-Check-Act (PDCA) methodology.
  • An interdisciplinary team identified workflow delays and implemented three evidence-based interventions.
  • Retrospective chart review established a baseline TTA of 128 minutes.

Main Results:

  • Mean TTA was reduced to 53 minutes.
  • 83% of patients received antibiotics within the 60-minute goal.
  • Significant improvement in timely antibiotic delivery was observed.

Conclusions:

  • Interventions targeting provider and nursing workflows effectively decreased TTA.
  • Implementation of an evidence-based practice nursing order set was the most impactful intervention.
  • This quality improvement initiative successfully enhanced the timeliness of antibiotic delivery.
Abstract

Keywords:
Antibiotic timeEmergencyFeverNeutropeniaPediatric oncology

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