BACKGROUND Infections cause significant morbidity and mortality in patients with chemotherapy-induced neutropenia. Nursing practices exist that are proven to reduce infections in this population, however compliance with them is not routinely monitored. METHODS A quality improvement project was designed to monitor compliance with established Neutropenic Precautions (NP-bundle) for inpatient neutropenic cancer patients on an Oncology Unit from July 2015 through September 2018. A novel auditing tool was developed which included a patient interview, observation, and evaluation of the environment. Audits were scored by the infection preventionist IP) for compliance. The project was organized into four time-periods: Baseline period: All audits performed by IP to determine feasibility and areas of focus. Phase I was educating staff and fixing gaps discovered in the baseline period. Unit nurses trained to perform all audits. Phase II, unit leadership engagement and enforcement of mandatory number of audits to add accountability of auditing frequency. Phase III was the Sustainment period with reduction in unit leadership involvement. RESULTS Audit scores significantly increased between baseline period (mean= 60%) and Phase I (mean= 82%, p CONCLUSIONS We developed a novel tool to assess compliance with key elements of neutropenic precautions. Education and peer auditing was associated with improved compliance. Engagement of unit leadership and increasing audit volume correlated with further improvement with compliance, which was sustainable with less direct leadership involvement.
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