Doctor of Nursing Practice
Joan O’Rourke, DNP, MBA, RN
Marilyn Omabegho, MSN, RN, NE-BC
Introduction—Significance and Background: Febrile Neutropenia (FN) is the most common and serious complication of hematopoietic cancers and in patients receiving chemotherapy. Patients in this immunocompromised state have weakened immunity to fight off infection and a mortality rate of almost 10%. Thus, Infectious Diseases Society of America has identified the single most important determining factor of outcomes is the timing of antibiotic (TTA) administration and has identified the gold standard to be 60 minutes. Current practice does not follow guidelines and the current policy does not address the urgency of antibiotic administration.
Purpose: The purpose of this project is to improve the care of FN patients by administering antibiotics within one hour of identification of neutropenia.
Interventions and Setting: The focus of this project occurred in the emergency department (ED) of a 230-bed acute care hospital, affiliated with a large healthcare system, located in Somerville, NJ. The population of focus was adult oncology patients presenting with a chief complaint of fever and subsequently found to be neutropenic. Using keywords from the PICO search question, a literature review was conducted using the following databases: CINAHL Complete, Cochrane Database of Systematic Reviews, MEDLINE, and Proquest. From the evidence search, a total of five articles fit the criteria for review that had a focus of timing of antibiotic administration. ED staff nurses were educated on FN using evidence-based practice, in alignment with the Institute of Medicine goals of providing safe, effective, and timely care.
Evaluation: 88.7% of ED staff nurses were educated on the importance of timely antibiotic administration. Post-education demonstrated 52.94% of patients received antibiotics within 60 minutes, compared to 17.65%, pre-education. Overall TTA decreased from 6.61 hours to 1.13 hours. Hospital length of stay decreased from 7.91 days to 5.8 days; and there were zero ICU admissions or mortalities post-education.
Discussion: Based on the literature, it is recommended to implement staff education in order to administer antibiotics within one hour to FN patients. Administering antibiotics within one hour has proven to decrease length of stay, mortality rates, and ICU admissions.
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Murray, K. (2022). Decreasing time to antibiotic administration in febrile neutropenic adult oncology patients in the emergency department: An evidence-based quality improvement project [Unpublished DNP project]. Sacred Heart University.