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Optimizing Time to Antibiotic Administration in Children with Possible Febrile Neutropenia through Quality

Beech Burns1, Melinda Hartenstein1, Amber Lin1

  • 1Department of Emergency Medicine, Oregon Health and Science University, Portland, Ore.

Pediatric Quality & Safety
|February 4, 2020
PubMed

Insights

Prompt antibiotic administration for febrile neutropenia in children is crucial. A quality improvement initiative successfully reduced time to antibiotic (TTA) delivery to under 60 minutes for over 80% of pediatric oncology patients.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Quality Improvement Science

Background:

  • Febrile neutropenia is a serious chemotherapy complication in children.
  • Timely antibiotic treatment is vital for reducing morbidity and mortality.
  • A <60-minute time to antibiotic (TTA) administration is a key quality metric.

Purpose of the Study:

  • To implement a quality improvement initiative to achieve TTA < 60 minutes in >80% of eligible pediatric oncology patients.
  • To enhance the promptness of antibiotic delivery in a pediatric emergency department setting.

Main Methods:

  • Utilized Plan-Do-Study-Act (PDSA) cycles to streamline antibiotic ordering and preparation.
  • Focused on reducing time from patient arrival to antibiotic order.
  • Implemented pharmacy expediting and pre-arrival ordering strategies.
  • Employed statistical process control for outcome measurement.

Main Results:

  • Mean TTA decreased from 64 to 53 minutes post-intervention.
  • Percentage of patients receiving antibiotics within <60 minutes increased from 59% to 84%.
  • Sustained improvements were observed, with 85% of patients receiving antibiotics within the goal time.

Conclusions:

  • A multi-cycle PDSA initiative effectively reduced TTA in pediatric febrile neutropenia patients.
  • The initiative significantly increased the proportion of patients receiving timely antibiotic therapy.
  • The quality improvement strategy successfully met and sustained the <60-minute TTA benchmark.

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