Supportive Care in Cancer

, Volume 23, Issue 7, pp 2079–2087 | Cite as

Management of fever and neutropenia in children with cancer

  • A. Vedi
  • V. Pennington
  • M. O’Meara
  • K. Stark
  • A. Senner
  • P. Hunstead
  • K. Adnum
  • W. Londall
  • L. Maurice
  • Claire Wakefield
  • R. J. Cohn
Original Article

Abstract

Purpose

Febrile neutropenia remains a common, life-threatening complication of chemotherapy in paediatric oncology. Delays in institution of empiric antibiotics have been identified at tertiary and regional centres caring for these patients and associated with decreased survival. Our objective was to reduce the time to administration of empiric antibiotics to less than 60 min from the time of presentation to hospital.

Methods

A retrospective study of the records of oncology patients presenting to the emergency department of a tertiary hospital over a 3-month period was performed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified and an algorithm-based approach to the management of fever in immunocompromised children developed and implemented. Follow-up evaluation data were collected at 12 and 60 months post-intervention. Causes of delay in commencement of antibiotics at regional hospitals that share care with the tertiary hospital were identified through questionnaires, interviews and focus groups, involving patients and medical and nursing staff. The impact of the introduction of the algorithm at one peripheral hospital was evaluated.

Results

The mean time to empiric antibiotics was reduced from 148 min (95 % confidence interval (CI) 81–216) at baseline to 76 min (95 % CI 50–101) at 12 months post-intervention and sustained at 65 min (95 % CI 52–77) 5 years after the intervention. At the peripheral hospital, mean time to antibiotic delivery was reduced from 221 min (95 % CI 114–328) to 65 min (95 % CI 42–87) at 12 months after the intervention.

Conclusion

The introduction of the guideline, with teaching and support for staff and parents, resulted in an improvement in practice, meeting international guidelines and achieving sustained results at 5 years after introduction at a tertiary hospital. The guideline has been shown to be feasible and effective at a regional hospital.

Keywords

Febrile neutropenia Paediatrics Oncology 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • A. Vedi
    • 1
    • 4
  • V. Pennington
    • 2
  • M. O’Meara
    • 2
  • K. Stark
    • 2
  • A. Senner
    • 1
  • P. Hunstead
    • 2
  • K. Adnum
    • 1
  • W. Londall
    • 1
  • L. Maurice
    • 1
  • Claire Wakefield
    • 1
    • 3
    • 4
  • R. J. Cohn
    • 1
    • 4
  1. 1.Kids Cancer CentreSydney Children’s HospitalRandwickAustralia
  2. 2.Children’s Emergency DepartmentSydney Children’s HospitalRandwickAustralia
  3. 3.Behavioural Sciences Unit, Kids Cancer CentreSydney Children’s HospitalRandwickAustralia
  4. 4.School of Women’s and Children’s HealthUniversity of New South WalesRandwickAustralia

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