Qi Project to Reduce Time to Antibiotic Administration in Febrile Children with Malignancy

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Journal of Investigative Medicine





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Purpose of study Neutropenia is a common finding in children who undergo chemotherapy. Fever is usually the only presenting sign of a serious bacterial infection in these patients. Our quality improvement project aims to identify these patients and further to reduce the time taken to administer antibiotics. Chemotherapy-induced neutropenia is typically prolonged due to bone marrow insult, increasing the risk of serious bacterial infection. Although studies have not yet clearly demonstrated a link between early administration of antibiotics and prevention of sepsis in these patients, the national standard is to administer antibiotics in less than 60 min. Objective To identify the time taken for antibiotic administration in children with malignancy who present with fever to the paediatric emergency room at Sunrise Children’s Hospital, Las Vegas. Identify steps involved from triage of patient to administration of antibiotic, and measure the time taken for each individual step. Implement measures to reduce the time for antibiotic administration to less than 60 min, using PDSA cycle technique. Sustain the results, and re–evaluate for next cycle of PDSA cycle. Methods used We employed the Plan-Do-Study-Act (PDSA) method. Initial planning showed the potential bottlenecks such as rooming and ordering of antibiotics. We developed a new protocol for these patients based on a risk-stratification system. We hypothesised that the new clinical protocol would reduce the time for ordering antibiotics for our patients. Data were continually collected during the study period to monitor time taken for antibiotic administration. Summary of results Our initial analysis shows that we reduced the time for antibiotic administration from an average of 120 min to a little over 90 min. We identified that majority of time taken was from triage to ordering antibiotics, and from ordering of antibiotics to delivery of antibiotics by pharmacy. Conclusions Future directions: We are currently creating a code team for febrile children with malignancy, wherein there will be a special pager connecting the paediatric emergency room to the pharmacy to reduce the time taken for delivering antibiotics for our study population.


Medicine and Health Sciences



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