1
|
Smith WT, Read J, Agarwal S, Tian G, Anum SJ, Choe M, Kurtz K, Tlais D, Shen X, Sarro J, Looney T, Porea T, Sauer H, Brackett J, Okcu MF, Chintagumpala M. Improving Time to Antibiotic Administration for Pediatric Oncology Patients With New-Onset Fever. JCO Oncol Pract 2024; 20:725-731. [PMID: 38354362 DOI: 10.1200/op.23.00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Time to antibiotic administration (TTA) in <60 minutes for children with neutropenic fever presenting to an emergency room is associated with reduced incidence of sepsis and intensive care admission. As such, TTA is used as a national quality metric for pediatric oncology patients. At our center, in 2020, 19% of the hospitalized patients with a new fever encounter were receiving antibiotics in <60 minutes, prompting a multidisciplinary approach to reach a goal of >90% in all pediatric patients with cancer with a new fever. METHODS A multidisciplinary team completed four Plan-Do-Study-Act cycles between March 2021 and September 2023. We implemented education initiatives, an updated handoff smartphrase guiding the on-call team, an antibiotic champion (AC) nursing role, a revised fever plan for handoff, a rapid-response team to address new fevers, and an algorithm for blood culture collection. Data were collected, analyzed, and reported biweekly with feedback sought for delays in TTA. RESULTS There was a total of 639 new fevers in 329 unique oncology patients. As of September 4, 2023, average TTA decreased from 89 minutes at baseline to 46.4 minutes for more than 12 months. The percentage of patients receiving first dose of antibiotic in <60 minutes also increased from 19% to 93.7%, which was sustained as well. The most effective interventions were creation of the AC role and streamlining the blood culture collection process. CONCLUSION This project demonstrates the importance of multidisciplinary involvement for providing optimal care. Specific implementation of targeted education, an AC role, and development of an algorithm streamlining the processes led to meaningful targeted improvements. Further analyses will explore the impact of these interventions on patient outcomes.
Collapse
Affiliation(s)
- Wesley T Smith
- Department of Pediatrics, Division of Hematology/Oncology, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, KY
| | - Jay Read
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Shreya Agarwal
- Department of Pediatrics, Division of Hematology, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Gengwen Tian
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Shaniqua J Anum
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Michelle Choe
- Clinical Research Division, Department of Pediatrics, Fred Hutchinson Cancer Center, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Kristen Kurtz
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Dana Tlais
- Department of Oncology, Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Xiaofan Shen
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jill Sarro
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Thomas Looney
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Timothy Porea
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Hannah Sauer
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Julienne Brackett
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - M Fatih Okcu
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Murali Chintagumpala
- Department of Pediatrics, Texas Children's Hematology and Oncology Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| |
Collapse
|
2
|
Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use. JAC Antimicrob Resist 2023; 5:dlad123. [PMID: 38021036 PMCID: PMC10667038 DOI: 10.1093/jacamr/dlad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities. Conclusions Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
Collapse
Affiliation(s)
- Maria Bos
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cindy De Bot
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
3
|
Rodrigues JAP, Lacerda MR, Galvão CM, Gomes IM, Meier MJ, Caceres NTDG. Nursing care for patients in post-transplantation of hematopoietic stem cells: an integrative review. Rev Bras Enferm 2021; 74:e20200097. [PMID: 34259727 DOI: 10.1590/0034-7167-2020-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/07/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the available evidence on the nursing care provided to patients after hematopoietic stem cell transplantation. METHODS integrative review with the search for primary studies in four databases and a virtual health library. A broad search strategy was used, including research published in English, Brazilian Portuguese, or Spanish, between 2008 and 2018, totaling a sample of 42 studies. RESULTS the studies were grouped into three categories: multiple nursing care (n=19), first-line care (n=18), and self-management of care (n=5). CONCLUSIONS nursing care is critical, comprising patients' physical, psychological and social aspects. It occurs in hospital and home contexts, mainly involving technical actions and health guidance. The evidence identified provide subsidies for decision-making; however, most studies are of the non-experimental type, indicating the need for conducting intervention research.
Collapse
|
4
|
Fananapazir N, Dandoy C, Byczkowski T, Lane A, Nagarajan R, Hariharan S. Study of Delayed Antibiotic in Pediatric Febrile Immunocompromised Patients and Adverse Events. Hosp Pediatr 2019; 9:379-386. [PMID: 31015220 DOI: 10.1542/hpeds.2018-0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Bone marrow transplant (BMT) patients or patients receiving chemotherapy for oncologic diagnoses are at risk for sepsis. The association of time to antibiotics (TTA) with outcomes when adjusting for severity of illness has not been evaluated in the pediatric febrile immunocompromised (FI) population. We evaluated the association of TTA with adverse events in a cohort of FI patients presenting to our pediatric emergency department. METHODS We performed a retrospective review of consecutive FI patients presenting over a 6.5-year period. Adverse events were defined as intensive care admission within 72 hours of emergency department arrival, laboratory signs of acute kidney injury, inotropic support subsequent to antibiotics, and all-cause mortality within 30 days. Vital signs and interventions were used to define severity of illness. Adjusting for severity of illness at presentation, age, and timing of an institutional intervention designed to reduce TTA in FI patients, we analyzed the association of TTA with individual adverse events as well as with adverse events in aggregate. RESULTS We analyzed 1489 patient encounters. In oncology patients, TTA was not associated with the aggregate measure of whether any adverse event subsequently occurred nor with other individual adverse events. For the BMT subpopulation, TTA >60 minutes did show increased odds of intensive care admission within 72 hours as well as for aggregate adverse events. CONCLUSIONS Although TTA >60 minutes did show increased odds of aggregate adverse events in the small subgroup of BMT patients, overall TTA was not associated with adverse events in oncology patients as a whole.
Collapse
Affiliation(s)
| | - Christopher Dandoy
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Terri Byczkowski
- Division of Emergency Medicine and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Adam Lane
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Rajaram Nagarajan
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Selena Hariharan
- Division of Emergency Medicine and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|