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Supportive Care in Cancer

, Volume 24, Issue 12, pp 5001–5005 | Cite as

A nurse-led protocol improves the time to first dose intravenous antibiotics in septic patients post chemotherapy

  • Graeme Mattison
  • Matthew Bilney
  • Phil Haji-Michael
  • Tim CooksleyEmail author
Original Article

Abstract

Purpose

Neutropenic sepsis is a time-dependent emergency with early interventions shown to improve outcomes. Broad spectrum intravenous antibiotic administration is the initial therapy in patients with suspected neutropenic sepsis. Compliance with early antibiotic administration in febrile neutropenia patients is poor. Innovations have been trialled to improve the time to first dose intravenous antibiotics in patients with suspected neutropenic sepsis. Consideration of extending first dose intravenous antibiotic prescribing to trained nursing staff may improve performance in this key standard.

Methods

A retrospective analysis was performed at a specialist oncology hospital in the North West of England from January 1st 2015 to January 31st 2016. The nurses on the Medical Admissions Unit (MAU) have been given the responsibility of assessing patients presenting with fever post chemotherapy including prescribing and administering the first dose of intravenous antibiotics with the aim of improving the speed of this intervention.

Results

During the study period, 697 patients presented to the MAU with suspected sepsis post chemotherapy. Six hundred seventy-two (96.4 %) patients received their first dose of intravenous antibiotics within 60 min of presentation to the MAU. Of this group, 323 (48.1 %) were administered antibiotics within 15 min of arrival. Of the 25 (3.6 %) patients who did not receive antibiotics within 1 h, root cause analysis revealed the reason in 23 (92 %) patients was an inability to ascertain intravenous access.

Conclusion

Nurse-led protocols are an effective, safe, and sustainable method for achieving early antibiotic administration in patients with suspected febrile neutropenia. This is a key component of ensuring improved outcomes for this cohort of patients.

Keywords

Neutropenia Sepsis Time to antibiotics Nurse-led Chemotherapy 

Notes

Acknowledgments

The authors would like to thank the nurses on the MAU at The Christie for their continued work in making the PGD a success story.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Angus D, van der Poll T (2013) Severe sepsis and septic shock. N Engl J Med 369:840–851CrossRefPubMedGoogle Scholar
  2. 2.
    Dellinger R, Levy M, Rhodes A, et al. (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41(2):580–637CrossRefPubMedGoogle Scholar
  3. 3.
    Daniels R (2011) Surviving the first hours in sepsis: getting the basics right. J Antimicrob Chemother 66:ii11–ii23CrossRefPubMedGoogle Scholar
  4. 4.
    Klastersky J, Paesmans M, Rubenstein E, et al. (2000) The Multinational Association for Supportive Care in cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18:3038–3051PubMedGoogle Scholar
  5. 5.
    Klastersky J, Paesmans M (2013) The Multinational Association for Supportive Care in cancer (MASCC) risk score: 10 years of use for identifying low risk neutropenic cancer patients. Support Care Cancer 21:1487–1495CrossRefPubMedGoogle Scholar
  6. 6.
    Cooksley T, Holland M, Klastersky J (2015) Ambulatory outpatient management of patients with low risk febrile neutropaenia. Acute Med 14(4):178–181PubMedGoogle Scholar
  7. 7.
    2012 NICE Guideline. Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patientsGoogle Scholar
  8. 8.
    Flowers C, Seidenfeld J, Bow E, et al. (2013) Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Onc 31:794CrossRefGoogle Scholar
  9. 9.
    Rosa R, Goldani L (2014) Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother 58(7):3799–3803CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Perron T, Emara M, Ahmed S (2014) Time to antibiotics and outcomes in cancer patients with febrile neutropenia. BMC Health Serv Res 14:162CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Friefeld A, Bow E, Sepkowitz K, et al. (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:e56–e93CrossRefGoogle Scholar
  12. 12.
    Nirenberg A, Mulhearn L, Lin S, Larson E (2004) Emergency department waiting times for patients with cancer with febrile neutropenia. Oncol Nurs Forum 31(4):711–715CrossRefPubMedGoogle Scholar
  13. 13.
    Clarke R, Warnick J, Stretton K, Littlewood T (2011) Improving the immediate management of neutropenic sepsis in the UK: lessons from a national audit. Br J Haematol 153:773–779CrossRefPubMedGoogle Scholar
  14. 14.
    Keng M, Thallner E, Elson P, Ajon C, Sekeres J, et al. (2015) Reducing time to antibiotic administration for febrile neutropenia in the emergency department. J Oncol Pract 11(6):4505CrossRefGoogle Scholar
  15. 15.
    Meisenberg B, Clemons J, Ness J, Faust N, Clance M (2015) Improving hospital performance in the treatment of febrile neutropenia. Support Care Cancer 23:371–375CrossRefPubMedGoogle Scholar
  16. 16.
    Szwajcer D, Czaykowski P, Turner D (2011) Assessment and management of febrile neutropenia in emergency departments within a regional health authority—a benchmark analysis. Curr Oncol 16:280–284Google Scholar
  17. 17.
    Sammut S, Mazhar D (2012) Management of febrile neutropenia in an acute oncology service. QJM 105:327–336CrossRefPubMedGoogle Scholar
  18. 18.
    Parish B, Cooksley T, Haji-Michael P (2013) Effectiveness of early antibiotic administration in septic patients with cancer. Acute Med 12(4):196–200PubMedGoogle Scholar
  19. 19.
    Burry E, Punnet A, Mehta A, Thull-Freedman J, et al. (2012) Identification of educational and infrastructural barriers to prompt antibiotic delivery in febrile neutropenia: a quality improvement initiative. Pediatr Blood Cancer 59:431–435CrossRefPubMedGoogle Scholar
  20. 20.
    Best J, Frith K, Anderson F, Rapp C, et al. (2011) Implementation of an evidence based order set to impact initial antibiotic time intervals in adult febrile neutropenia. Oncol Nurs Forum 38:661–668CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Graeme Mattison
    • 1
  • Matthew Bilney
    • 1
  • Phil Haji-Michael
    • 1
  • Tim Cooksley
    • 1
    Email author
  1. 1.Department of Acute Medicine and Critical CareThe ChristieManchesterUK

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