Use of a fever fast track tool to reduce time to antibiotic dose in febrile pediatric oncology patients.

Abstract

222 Background: Given the risk of serious bacterial infection in immunocompromised cancer patients, fever should be promptly treated with empiric antibiotics. Our institutional standard is to administer antibiotics in ≤ 60 minutes from on-site fever or from arrival time with known fever. Review of our febrile outpatient pediatric oncology clinic patients from October-December 2013 revealed that 53% met this metric. Our aim: To achieve a sustained rate of 80% of febrile patients receiving antibiotics in ≤ 60 minutes within 8 weeks. Methods: We developed and implemented a fever fast track tool in our pediatric oncology clinic. Providers time stamped each step in the process from fever to antibiotic administration; additional time points were collected from the medical record. Interviews with staff were conducted to identify barriers. Five revisions of the fever fast track tool were made. We also streamlined same-day encounters for febrile patients in order to flag their acute visits and facilitate pre-arrival order entry. Results: 21 patients were treated for fever between 2/26/14 and 4/17/14. 4 fevers were documented in clinic. Time to antibiotics ranged from 23 minutes to 165 minutes. The median time to antibiotic administration was reduced from 58 minutes during the first four weeks to 40 minutes after the second 4-week block. Over the same period, patients receiving antibiotics in ≤ 60 minutes increased from 62% to 88%. Conclusions: Use of a fever fast track tool improved the proportion of febrile patients receiving antibiotics in ≤ 60 minutes. Modifications facilitating antibiotic order entry and pre-arrival awareness of febrile patients should prove helpful in sustaining this success.