Implementation of a nursing based order set: Improved antibiotic administration times for pediatric ED patients with therapy-induced neutropenia and fever

Tana Lukes, Katharine Schjodt, Leeza Struwe

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: For patients with chemotherapy-induced neutropenia and fever, delays in antibiotic administration are associated with poor outcomes, such as ICU admission and need for further interventions. The objective of this quality improvement project was to significantly reduce the time from initiation of triage to antibiotic administration for pediatric patients arriving to the emergency department with therapy-induced neutropenia and fever. Methods: An interdisciplinary team set an evidence-based goal for time to antibiotics (TTA) at 60-min. A six-month retrospective chart review of Emergency Department (ED) patients revealed a 128 min TTA mean when measured from the initiation of triage to antibiotic administration, which also reflected 0% of patients receiving antibiotics within the goal of 60 min. Members of the interdisciplinary team evaluated delays in patient care workflow and identified three primary interventions to decrease the TTA. These three evidenced-based interventions were implemented and evaluated using the Plan-Do-Check-Act (PDCA) quality improvement methodology. Results: By the end of the implementation period mean TTA improved to 53 min and patients received antibiotics within 60 min (83% of the time). Conclusion: The interventions focused on both provider and nursing workflow, however the implementation of an evidence-based practice nursing order set made the greatest impact on timeliness of antibiotic delivery time.

Original languageEnglish (US)
Pages (from-to)78-82
Number of pages5
JournalJournal of pediatric nursing
Volume46
DOIs
StatePublished - May 1 2019

Fingerprint

Neutropenia
Hospital Emergency Service
Nursing
Fever
Pediatrics
Anti-Bacterial Agents
Therapeutics
Workflow
Triage
Quality Improvement
Evidence-Based Nursing
Evidence-Based Practice
Patient Care
Drug Therapy

Keywords

  • Antibiotic time
  • Emergency
  • Fever
  • Neutropenia
  • Pediatric oncology

ASJC Scopus subject areas

  • Pediatrics

Cite this

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title = "Implementation of a nursing based order set: Improved antibiotic administration times for pediatric ED patients with therapy-induced neutropenia and fever",
abstract = "Purpose: For patients with chemotherapy-induced neutropenia and fever, delays in antibiotic administration are associated with poor outcomes, such as ICU admission and need for further interventions. The objective of this quality improvement project was to significantly reduce the time from initiation of triage to antibiotic administration for pediatric patients arriving to the emergency department with therapy-induced neutropenia and fever. Methods: An interdisciplinary team set an evidence-based goal for time to antibiotics (TTA) at 60-min. A six-month retrospective chart review of Emergency Department (ED) patients revealed a 128 min TTA mean when measured from the initiation of triage to antibiotic administration, which also reflected 0{\%} of patients receiving antibiotics within the goal of 60 min. Members of the interdisciplinary team evaluated delays in patient care workflow and identified three primary interventions to decrease the TTA. These three evidenced-based interventions were implemented and evaluated using the Plan-Do-Check-Act (PDCA) quality improvement methodology. Results: By the end of the implementation period mean TTA improved to 53 min and patients received antibiotics within 60 min (83{\%} of the time). Conclusion: The interventions focused on both provider and nursing workflow, however the implementation of an evidence-based practice nursing order set made the greatest impact on timeliness of antibiotic delivery time.",
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