P2D199: Optimizing Time to Antibiotic Administration in Pediatric Oncology Patients with Febrile Neutropenia

Purpose/Objectives: For pediatric oncology patients with febrile neutropenia (FN), timely administration of antibiotics decreases morbidity and mortality. The standard of care from the Infectious Diseases Society of America is to infuse broad-spectrum antibiotics in < 120 minutes from patient presentation, with many pediatric institutions moving this target to < 60 minutes. This is a quality improvement project to evaluate the impact of two education interventions implemented to improve time to first dose of antibiotics in pediatric patients presenting to the Emergency Department (ED) with known or suspected FN.

Design/Methods: Pediatric oncology patients ages 6 months to 19 years with suspected FN, defined as an ANC < 500, had baseline data collected from June- September 2022, from electronic health records and data generated reports from EPIC and was placed in Excel. Data from each patient visit included: Time/date of arrival to the ED, time of antibiotic order, time antibiotic verified by pharmacy, time ED nurse acknowledged and then administered the antibiotic.

The study intervention consisted of providing education to all staff via email and staff meetings prior to project launch on October 1, 2022. A second intervention was aimed at providers and consisted of individual and group outreach via Teams at the end of December. Post-intervention data was collected through March 2023.
Overall time from arrival to antibiotic administration, time from arrival to antibiotic order, and antibiotic order to antibiotic administration were analyzed using QI Macros. Control charts were used to track data changes over time and to assess variation.

Results: A total of 42 patients, with average age of 7.4 years, were included. This improvement demonstrated special cause variation in the time period after personalized provider education had been provided. Control charts evaluating the time frame between 1) ED arrival and placing the antibiotic order (Figure 1); 2) antibiotic order and administration; and 3) overall ED arrival to antibiotic administration (Figure 2). The time from ED arrival to antibiotic order decreased from 34 to 13 minutes. The time from antibiotic order to administration improved from 50 to 32 minutes. Overall time from ED arrival to antibiotic administration improved from 84 to 40 minutes.

Conclusion/Discussion: While education on an individual level showed the most impact, we realize that education alone is not sustainable. Our next step will be to introduce a new clinical pathway and order-set for this patient population which we hope will continue to improve our metrics. Our goal is that > 90% of pediatric oncology patients with FN receive broad-spectrum antibiotics in < 60 minutes.