Quality Improvement Project Purpose
Delays in antibiotic administration for patients with chemotherapy-induced neutropenia and fever are associated with poor outcomes, such as ICU admission and the need for further interventions (Lukes et al., 2019). After a local delay in antibiotic delivery resulted in an intensive care unit stay for one patient, an interdisciplinary team worked to put quality improvement measures in place to improve promptness of antibiotic administration. The objective of this quality improvement project was to “significantly reduce the time from initiation of triage to antibiotic administration for pediatric patients arriving to the emergency department with therapy-induced neutropenia and fever” (Lukes et al., 2019, p. 78).
Continuous Quality Improvement Tool Used
The continuous quality improvement (CQI) tool used within this study to evaluate data was the Plan-Do-Check-Act (PDCA) model. After a retrospective chart review, the team was able to identify where delays in the initiation of antibiotics possibly occurred. Three primary interventions were chosen as a result of this baseline data evaluation. The three interventions included: (a) creation of an EMR provider order set, (b) practice change to administer a broad-spectrum antibiotic before receiving laboratory results, and (c) creation of a triage nurse order set. As each intervention was implemented, data was evaluated utilizing the PDCA model.
Team Members and Their Roles
The interdisciplinary team that conducted the project consisted of hematology/oncology (H/O) physicians, emergency department (ED) physicians and nurse practitioners, ED clinical nurses, the H/O Clinical Nurse Specialist (CNS), a pharmacist, and members of the Information Technology (IT) department. The IT department helped to create an order set accessible in the electronic medical record (EMR) for ED providers. Specific roles of each interdisciplinary team member were not discussed: it appeared to be a collaborative effort amongst all team members mentioned above.
My View of the Outcome
Overall, time to antibiotics (TTA) was decreased from an average of 128 min to <60 min utilizing three interventions. All three interventions were shown to be effective. I believe the PDCA model was an appropriate model to evaluate the three interventions. Due to a sequence of actions that needed to occur to complete the antibiotic administration, I think the use of a process flowchart had the potential to be beneficial. A swimlane flowchart may have also been beneficial to highlight specific care provider roles. The large interdisciplinary workgroup for collaboration appeared to be sufficient. I found this study interesting because, in my current practice setting, we have trialed and implemented different interventions to decrease TTA however, a triage nurse order set is not one of them.
References
Lukes, T., Schjodt, K., & Struwe, L. (2019). Implementation of a nursing based order set: Improved antibiotic administration times for pediatric ED patients with therapy-induced neutropenia and fever. Journal of Pediatric Nursing, 46, 78–82. https://doi.org/10.1016/j.pedn.2019.02.028