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Pediatric bone marrow transplant and immune compromised patients are at high risk of infection due to neutropenia and need prompt administration of antibiotics. Therefore, early intervention with antibiotic administration is thought to decrease patient mortality. To ensure early intervention, the reduction of the amount of time between patient arrival to the outpatient clinic and administration of antibiotics within 60 minutes for all patients who are known or suspected to be neutropenic or immune-compromised is considered to be critical.
Methods:
A Plan, Do, Study, Act model adopted by a multi-disciplinary Hematology/Oncology ambulatory team was utilized to develop and implement a process ensuring antibiotic administration within 60 minutes of arrival. Identification of key drivers, believed to be essential to the success of the process, directed the development of interventions. The interventions focused on team communication and awareness, staff and family education, utilization of timers, and patient pre-registration.
Results:
The baseline amount of time from patient arrival to administration of antibiotic was 125 minutes. Over a four month period this time was reduced to less than 60 minutes. These results have been sustained at <90% over the last 15 months.
Conclusion
Expedient antibiotic administration is vital in the pediatric bone marrow transplant and immune compromised patient population. Further review is being conducted to determine what impact antibiotic administration within one hour has on overall patient outcomes. Having a process in place for early recognition and treatment are key to implementing best practice. Continuing to evaluate the process and examining failures and applying lessons learned are also drivers to sustaining compliance.
Quarters |
% Antibiotics within 60 min |
Jan-Mar 2011 |
5% |
Apr-June 2011 |
65% |
July-Sept 2011 |
93% |
Oct-Dec 2011 |
94% |
Jan-Mar 2012 |
100% |
Apr-June 2012 |
92% |
July-Sept 2012 |
100% |