QIM19-129: Utilization of Electronic Medical Record to Improve Outcomes in the Treatment of Febrile Neutropenia

Introduction: Chemotherapy-induced febrile neutropenia is a medical emergency. Delays in time to appropriate broad spectrum antibiotic therapy significantly increase morbidity and mortality. The purpose of this project is to improve outcomes in febrile neutropenia patients within our institutions by hard wiring compliance to NCCN Guidelines and IDSA guidelines via our electronic medical record (EMR). Methods: During initial chemo teaching, patients were instructed to present for emergency care immediately on noticing a fever. Patients were given a pocket card stating that the patient had recently received chemotherapy, indicating the patient’s neutropenia risk, and listing directions to a newly created febrile neutropenia page on the health system’s website. ED staff was educated that chemotherapy patients presenting with fever should be triaged to a high acuity level, which resulted in the patient being roomed immediately and seen promptly. The EMR dashboard for ED staff was modified to include a section for febrile neutropenia, which included links to appropriate antibiotics and directions to hang immediately after blood cultures were drawn. The admission order set was also modified to include protective isolation and guideline-based antibiotic choices. 2 months following implementation, patients were pulled based on ICD10 codes for fever/infection and chemotherapy/cancer. 23 patients were identified who met the study criteria (10 patients pre-implementation, 13 patients post-implementation). Pediatric patients and patients admitted directly to the floor were excluded from analysis. Results: While numbers were small, there were 15 patients admitted during the study period. Eight patients met study criteria pre-initiative and seven post-initiative. Pre-initiative: 6 of 8 patients were roomed immediately; 6 of 8 patients received appropriate empiric antibiotics; 1 of 8 patients received first dose within 1 hour of presentation to ED. Post-initiative: 7 of 7 patients were roomed immediately; 6 of 7 patients received appropriate empiric antibiotics; 4 of 7 patients received first dose within 1 hour of presentation to ED. Conclusions: Despite small numbers and incomplete compliance with guidelines, we were able to identify a 2.8 day decrease in average length of stay (LOS) and a 1.3 day decrease in ICU LOS. Sample size was not large enough to determine statistical significance.

Abstract

Introduction: Chemotherapy-induced febrile neutropenia is a medical emergency. Delays in time to appropriate broad spectrum antibiotic therapy significantly increase morbidity and mortality. The purpose of this project is to improve outcomes in febrile neutropenia patients within our institutions by hard wiring compliance to NCCN Guidelines and IDSA guidelines via our electronic medical record (EMR). Methods: During initial chemo teaching, patients were instructed to present for emergency care immediately on noticing a fever. Patients were given a pocket card stating that the patient had recently received chemotherapy, indicating the patient’s neutropenia risk, and listing directions to a newly created febrile neutropenia page on the health system’s website. ED staff was educated that chemotherapy patients presenting with fever should be triaged to a high acuity level, which resulted in the patient being roomed immediately and seen promptly. The EMR dashboard for ED staff was modified to include a section for febrile neutropenia, which included links to appropriate antibiotics and directions to hang immediately after blood cultures were drawn. The admission order set was also modified to include protective isolation and guideline-based antibiotic choices. 2 months following implementation, patients were pulled based on ICD10 codes for fever/infection and chemotherapy/cancer. 23 patients were identified who met the study criteria (10 patients pre-implementation, 13 patients post-implementation). Pediatric patients and patients admitted directly to the floor were excluded from analysis. Results: While numbers were small, there were 15 patients admitted during the study period. Eight patients met study criteria pre-initiative and seven post-initiative. Pre-initiative: 6 of 8 patients were roomed immediately; 6 of 8 patients received appropriate empiric antibiotics; 1 of 8 patients received first dose within 1 hour of presentation to ED. Post-initiative: 7 of 7 patients were roomed immediately; 6 of 7 patients received appropriate empiric antibiotics; 4 of 7 patients received first dose within 1 hour of presentation to ED. Conclusions: Despite small numbers and incomplete compliance with guidelines, we were able to identify a 2.8 day decrease in average length of stay (LOS) and a 1.3 day decrease in ICU LOS. Sample size was not large enough to determine statistical significance.

Introduction: Chemotherapy-induced febrile neutropenia is a medical emergency. Delays in time to appropriate broad spectrum antibiotic therapy significantly increase morbidity and mortality. The purpose of this project is to improve outcomes in febrile neutropenia patients within our institutions by hard wiring compliance to NCCN Guidelines and IDSA guidelines via our electronic medical record (EMR). Methods: During initial chemo teaching, patients were instructed to present for emergency care immediately on noticing a fever. Patients were given a pocket card stating that the patient had recently received chemotherapy, indicating the patient’s neutropenia risk, and listing directions to a newly created febrile neutropenia page on the health system’s website. ED staff was educated that chemotherapy patients presenting with fever should be triaged to a high acuity level, which resulted in the patient being roomed immediately and seen promptly. The EMR dashboard for ED staff was modified to include a section for febrile neutropenia, which included links to appropriate antibiotics and directions to hang immediately after blood cultures were drawn. The admission order set was also modified to include protective isolation and guideline-based antibiotic choices. 2 months following implementation, patients were pulled based on ICD10 codes for fever/infection and chemotherapy/cancer. 23 patients were identified who met the study criteria (10 patients pre-implementation, 13 patients post-implementation). Pediatric patients and patients admitted directly to the floor were excluded from analysis. Results: While numbers were small, there were 15 patients admitted during the study period. Eight patients met study criteria pre-initiative and seven post-initiative. Pre-initiative: 6 of 8 patients were roomed immediately; 6 of 8 patients received appropriate empiric antibiotics; 1 of 8 patients received first dose within 1 hour of presentation to ED. Post-initiative: 7 of 7 patients were roomed immediately; 6 of 7 patients received appropriate empiric antibiotics; 4 of 7 patients received first dose within 1 hour of presentation to ED. Conclusions: Despite small numbers and incomplete compliance with guidelines, we were able to identify a 2.8 day decrease in average length of stay (LOS) and a 1.3 day decrease in ICU LOS. Sample size was not large enough to determine statistical significance.

Corresponding Author: Anna M. Gibson, PharmD

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