Nurse-led study on treatment delay and streamlining antibiotic therapy among haematology patients with febrile neutropenia post chemotherapy

Abstract

Objective: The aim of the study is to identify gaps that exist among health professionals that may impact practices in caring effectively for patients with febrile neutropenia (FN). Background: Haematology patients with FN following chemotherapy frequently experience delays in antibiotic administration that may be linked to poorer clinical outcomes. To aid timely review and treatment, FN care pathways have been developed. However, observations of clinical practice and patient anecdotal reports have highlighted that the care pathways may not be adhered to. The impact on patient care outcomes due to treatment delays and the rate of protocol adherence to the FN management pathway is unknown due to insufficient evidence. Methods: Using the Clinical Records Integrated System (CRIS), data were collected by auditing patients’ electronic health records (EHR) from November 2017 through to November 2018. Information retrieved were screened using the inclusion and exclusion criteria. Inclusion criteria: Haematology patients with FN (temperature ≥ 38° and neutrophil count < 1.0 x109/L) post chemotherapy, and 18 years or older. Exclusion criteria: Medical oncology patients and patients who were under 17 years old. Results: The mean time for antibiotic administration from first temperature spike was 90±15 minutes for inpatients (n=48). The mean time for antibiotic administration from medical officer review was significantly lower at 48±5 minutes for outpatients (n=31). Inpatients who were given antibiotics within 60 minutes or less of their first temperature spike, their mean length of total stay in the ward was 17±1 whilst inpatients who were given antibiotics 60 minutes after their first temperature spike, the mean length of their hospital stay was slightly greater at 21±3 days. Outpatients who were given antibiotics within 60 minutes or less of their first temperature spike, their mean length of stay was 12±2 days. For outpatients given antibiotics 60 minutes after their first temperature spike, their mean length of hospital stay was slightly shorter at 9±3 days. Conclusion: The study identified antibiotic delays among inpatient population, and with correlation to increased length of hospital stay and mortality. Another key factor identified in the study was delayed medical officer review although reasons for delays are outside of the scope this study to report. What is already known: Febrile neutropenia is a serious and life-threatening illness. Delays in antibiotic administration exists among healthcare facilities. Adherence to FN treatment guidelines among healthcare settings are challenging. What this review adds: Standardised orders to allow timely administration of antibiotic therapy that may reduce morbidity and mortality. Increased education on the seriousness and outcome from delayed antibiotics to patients, families, and healthcare staff. Further studies are required to standardise the clinical pathway and make antibiotics accessible for prompt delivery.