Tick Tock! Beating the Clock in Paediatric Febrile Neutropenia:
We identified that in our paediatric oncology unit (POSCU), many children with febrile neutropenia were not receiving life-saving intravenous antibiotics (IVABs) within the gold standard of 60 minutes. This was putting lives at unnecessary risk.
We aimed to use simple, sustainable QI methods to improve febrile neutropenia management to ensure that all children with confirmed or suspected febrile neutropenia received life-saving IVABs within 60 minutes.
We collected audit data and conducted staff questionnaires on febrile neutropenia management for baseline measures. We used QI methodology (process mapping, fishbone diagrams) to identify contributing factors before applying interventions using PDSA cycles. Interventions included febrile neutropenia teaching sessions, creation of a new clerking pro-forma with an “Oncology 8” initiative, and a paediatric oncology handbook. Time to IVABs was measured following each PDSA cycle, and compared from start to completion of all interventions to measure overall improvement.
At baseline, average time to IVABs was 61 minutes in 52 children- 73% received IVABs within one hour, and 80% within 2 hours. 20% children did not receive antibiotics until 3 hours after attending.
Following application of all interventions, the average time to IVABs reduced to 42 minutes in 32 children, with 93% children receiving IVABs within an hour. Median time to IVABs reduced from 52 to 37 minutes. Staff reported increased knowledge and confidence in managing febrile neutropenia, with a better understanding of the importance of rapid antibiotic therapy for this vulnerable patient population.
Overall, children with cancer now face greater risk of death from treatment-related infection than from malignancy. It is therefore an essential life-saving measure for children with febrile neutropenia to receive IVABs within one hour of presenting unwell. We have shown that simple interventions facilitate and motivate better management of febrile neutropenia; which ultimately saves lives.
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