A multipronged approach that incorporates all disciplines on the interprofessional cancer care team resulted in a 34% improvement in antibiotic initiation within 30 minutes of a neutropenia diagnosis on a 24-bed blood and marrow intensive care unit (BMT/ICU), according to study findings presented at the 48th Annual ONS Congress® in April 2023.
An interprofessional team of transplant physicians, oncologists, internal medicine, pharmacy, nursing, and laboratory that included ONS member Kathleen Shuey, MS, RN, ACNS-BC, AOCN®, reviewed monthly data on time of fever to blood cultures, blood cultures to antibiotics, and fever to antibiotics. They found opportunities to increase compliance with antibiotic initiation within 60 minutes and introduced a quality project to achieve that goal in a minimum of 70% of patients with febrile neutropenia.
They identified barriers such as antibiotics availability on the unit, sequencing, consistent education of new staff, laboratory personnel availability, and escalation of issues to non-oncology providers and implemented the following interventions:
- An audit form that assists with case reviews
- An SBAR (situation, background, assessment, and recommendation) tool that facilitates nursing-provider communication
- A decision tree that outlines the escalation process by provider team (separate charts for transplant versus internal medicine)
- Kits (that included supplies and required paperwork) that facilitate ease of obtaining blood cultures from a central line
Researchers collected baseline data from July–December 2020 and postimplementation data from May 2021–present. They found that the BMT/ICU’s compliance with administration of initial antibiotic within 60 minutes increased from 85% during baseline to 89% postimplementation. Additionally, antibiotic initiation within 30 minutes improved 34% from baseline (41%) to postimplementation (62%).
The interprofessional team meets every other month to discuss individual cases and additional opportunities to improve existing processes, the researchers said. The unit implements those actions as identified.
“Neutropenia in patients with cancer can be a result of the disease process, side effects of therapy, or immunosuppression,” the researchers said. “It can lead to life-threatening consequences, including increased mortality. Timely initiation of antibiotics contributes to successful outcomes of this at-risk group.”