Time Is of the Essence: Nursing Educational Tool on the Administration of STAT Antibiotics for Febrile Neutropenic Patients in a Transplant and Cellular Therapy Setting

Abstract

Topic Significance & Study Purpose/Background/Rationale Hematopoietic stem cell recipient patients are at particularly high risk for severe infections, often experiencing neutropenia for extended periods of time before engraftment. It's well documented that administering antibiotics urgently to the febrile neutropenic is critical to prevent sepsis, reducing mortality. Currently, the expectation at our institution is to administer all STAT ordered antibiotics within a 60 minute timeframe from the final order entry. This time point has presented as a challenge due to an array of factors across disciplines. Methods, Intervention, & Analysis Over a period of 7 months the compliance rate for administering STAT antibiotics on the hematology/oncology transplant unit was low, prompting the need for more detailed nursing education to increase adherence to existing stands of practice. There are many variables that may contribute to a delay in administration. Common delays include limited communication with providers, difficulty in drawing blood cultures, inadequate intravenous access, locating the drug, prescribed doses not stocked on the unit, and confusion over the decision of which drug to administer first. The objective was to create an easy to read educational tool addressing common nursing challenges in administering STAT antimicrobials. The tool serves as a guide to direct the nurse through the entire process from the initial assessment of a fever through administration of the drug. Key points were consolidated into one document using the ABCs mnemonic as an easy to remember format. Information such as the number of blood cultures needed, managing line access issues, or other potential delays are addressed and clarified. The sheet also emphasizes the importance of communicating with the provider on the patient's condition and what factors are causing delays of administering the drug. The tool reviews the importance of accurate documentation and entering an incident report if there are delays for quality improvement. Nurses were educated on this tool during change of shift huddles and were given the opportunity to review the material on their own and sign an accountability roster. No nursing practices were changed as a result of this education, however nursing processes were tightened. Findings & Interpretation In summary, providing nursing a consolidated educational handout has proven beneficial by heightening awareness of our rates of timely antibiotic administration, the importance of administering antibiotics within the 60 minute timeframe, and serves as a quick resource in time sensitive situations. Anecdotally, nursing reports increased confidence in their knowledge of resources and management of administering antimicrobials in febrile neutropenic patients. Discussion & Implications Ongoing evaluation of progress includes review of data at monthly unit patient safety meetings and identification of opportunities for improvement.