WASHINGTONAlthough leukemia patients with neutropenia need antibiotics promptly when fever strikes, hospital procedures can delay administration for many hours, according to Cathy Mazzone, RN, MS, OCN, patient care manager, National Institute on Aging, Bethesda, Maryland. A thorough analysis of the approach to neutropenia fever management by a busy leukemia unit cut the wait to just over an hour, she said at the 27th Annual Congress of the Oncology Nursing Society (abstract 22).
Implementing the philosophy that "Appropriate Treatment Assures Quality" (ATAQ) and working in concert with medical staff, an interdisciplinary team identified the sources of delay.
The team then developed strategies and materials to help the affected departments make it a priority to start neutropenic patients on antibiotics within an hour of either the discovery of the fever or their arrival at the emergency department. Oncologic, hematologic, and infectious disease experts validated the 1-hour goal, Ms. Mazzone said.
A 5- to 7-Hour Wait
Baseline studies showed that, on average, inpatients waited for antibiotics for more than 5 hours, and patients admitted through the emergency department waited 7 hours.
Barriers to prompt administration included lack of education among nurses and lack of recognition among staff in various departments, including pharmacists and emergency department physicians, that getting antibiotics to neutropenia patients is a high priority.
Education is key to changing this situation, the team decided. Mandatory in-service training for nurses and ancillary staff on the leukemia unit featured short lectures; discussion of case studies, including some from the unit’s own experience; practice calculating absolute neutrophil counts (ANCs); and Q&A handouts using nontechnical language appropriate for ward clerks. Amgen’s "Neutropenia A-Z" program is "excellent" for this purpose, Ms. Mazzone said.