Improving Antibiotic Timing in Febrile Neutropenia for Pediatric Oncology Patients with a Central Line

Background: Febrile neutropenia in pediatric oncology patients is considered a medical emergency. This population is at risk for infection-related complications due to their immunocompromised state. The purpose of this evidence-based quality improvement project was to reduce the time in minutes from admission to antibiotic administration to within 60 min in at least 90% of pediatric oncology patients with a central line presenting with febrile neutropenia. Methods: An order set titled "FAST BREAK-Fever Neutropenia Admission" was created to expedite care during the first hour of admission, including labs, blood cultures, and a one-time STAT dose of intravenous cefepime. Education was provided to all providers and nursing staff on the unit through inservices, handouts, emails, and computer reminders. Results: Within three months from the FAST BREAK order set implementation, compliance for administering antibiotics within 60 min from admission occurred in 100% of admissions. Other outcomes included 100% compliance in provider utilization of the order set, reduction in the average time from admission to antibiotic administration, and cost reduction related to cefepime waste. Discussion: The FAST BREAK order set is now considered the standard of care in the Pediatric Cancer Center at the University of Iowa Stead Family Children's Hospital. Maintaining the expectation of prompt antibiotic administration for febrile neutropenia in pediatric oncology patients with a central line will improve patient care, reduce adverse outcomes in this vulnerable population, and correlate with national guidelines for antibiotic administration in febrile oncology patients.