Aims
Suspected febrile neutropenia (FN) requires prompt assessment and management with administration of antibiotics within 60 minutes as per guidelines. An audit at our institution (which lacks an emergency department) identified poor adherence to guidelines. We aimed to reaudit our performance following several interventions.
Methods
Two audits were conducted at our centre – period one 2017 calendar year; period two October 2018 – October 2019. Patients were identified through hospital coding using the term ‘Agranulocytosis’. Medical records were retrieved for data collection. Between audit periods interventions included additional staff education; development of an "FN box" which included antibiotics and a treatment pathway/proforma and the opening of an acute medical unit (AMU).
Results
There were 72 admissions in period one, and 55 in period two. In both study periods appropriate antibiotics were administered in >90% of patients. The median time to antibiotics and compliance with 60 minutes to administration was: period one 135 minutes (range 15-5160) with 11% compliance; period two 80 minutes (range 0-2130 minutes) with 45% compliance. The mortality rate improved from 11% (period one) to 9% (period two). In period two the ward of admission was the major factor determining time to antibiotic therapy – AMU median 43 minutes (range 0-440 minutes) with 70% compliance; oncology ward median 98 minutes (range 0-2130 minutes) with 40% compliance; non-oncology ward median 190 minutes (range 0-750 minutes) with 7% compliance.
Conclusion
Auditing of routine care is required to ensure best practice. After identifying a gap in our routine care we were able to significantly improve performance with regards to management of FN. The introduction of an AMU was the most important intervention at our centre. The AMU allowed sufficient resources to address time critical tasks. Centres without an emergency department should consider similar pathways to ensure timely care for FN.