2.50
Hdl Handle:
http://hdl.handle.net/10755/306627
Category:
Abstract
Type:
Poster
Title:
Nurse Driven Protocols for Febrile Pediatric Oncology Patients
Author(s):
Dobrasz, Gina; Hatfield, Marianne; Jones, Laura; Berdis, Jennifer; Miller, Erin; Entrekin, Melanie
Lead Author STTI Affiliation:
Non-member
Author Details:
Gina Dobrasz, MS, RN, CNOR, gina.dobrasz@choa.org; Marianne Hatfield, MSN, RN, CENP; Laura Jones, BSN, RN; Jennifer Berdis, BSN, RN, CPN; Erin Miller, RN, CPN; Melanie Entrekin, RN
Abstract:

Evidence-based Practice Abstract

Purpose: Infection is a frequent complication experienced by many pediatric cancer patients with potentially life threatening consequences that may result in hospitalization, prolonged length of stay and increased mortality. The need for prompt assessment and early intervention for infection is widely recognized by Emergency Department staff as best practice, however, the average length of time to antibiotic administration varies widely in published studies.

Design: An interdisciplinary quality improvement initiative including physician, nursing, and pharmacy leaders was created to streamline the identification and treatment for this high-risk population. Based on published evidence for best practice and national recognition of the need for rapid treatment, the goal for administration of appropriate antibiotic therapy was changed to less than sixty minutes post Emergency Department arrival.

Setting: This project was conducted at two Emergency Departments in a pediatric healthcare system with 520 beds and a Level 1 and Level 2 trauma designation. Approximately 137,000 patients are seen annually. In the Emergency Departments, 271 staff members, including registered nurses, paramedics, and patient care technicians were educated about using the newly designed process.

Participants: Records from all patients with fever and a known history of pediatric cancer who presented to the Emergency Departments were included in the retrospective review. This included patients with solid tumors, acute lymphoblastic leukemia, acute myeloid leukemia, and chronic myelogenous leukemia. Exclusion criteria included patients in known remission, those with prior antibiotic therapy at another facility, congenital or drug induced neutropenia, or parental concern or objection to treatment.

Methods: A retrospective medical record review of febrile oncology patients treated from September 2008 until May 2012 was conducted to evaluate the impact of this evidence based practice change to streamline the "door to drug" process. The median length of time until antibiotic administration, and nurses' compliance initiating the protocol were determined.

Results/Outcomes: The review included 2,758 medical records. Over the study period from 2008 to 2012, one Emergency Department's median time for drug administration dropped from 106 to 39 minutes and the second dropped from 121 to 58 minutes, both below the 60 minute goal. Both campuses also improved their protocol compliance with Emergency Department 1 increasing from 24% to 78% and Emergency Department 2 improving from 30% to 84%.

Implications: This quality initiative has direct application for all Emergency Department leaders that treat pediatric oncology patients. High-risk patients can benefit from a streamlined nurse initiated process that decreases negative consequences of fever. Collaboration by interdisciplinary leadership within the healthcare facility as well as key stakeholder buy-in is imperative to achieve a process that may lead to decreased hospital stay, and reduced systemic infection or mortality for these vulnerable patients.

Keywords:
Pediatric Oncology
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Ft. Lauderdale, Florida, USA
Description:
2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleNurse Driven Protocols for Febrile Pediatric Oncology Patientsen_GB
dc.contributor.authorDobrasz, Ginaen_GB
dc.contributor.authorHatfield, Marianneen_GB
dc.contributor.authorJones, Lauraen_GB
dc.contributor.authorBerdis, Jenniferen_GB
dc.contributor.authorMiller, Erinen_GB
dc.contributor.authorEntrekin, Melanieen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsGina Dobrasz, MS, RN, CNOR, gina.dobrasz@choa.org; Marianne Hatfield, MSN, RN, CENP; Laura Jones, BSN, RN; Jennifer Berdis, BSN, RN, CPN; Erin Miller, RN, CPN; Melanie Entrekin, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306627-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Infection is a frequent complication experienced by many pediatric cancer patients with potentially life threatening consequences that may result in hospitalization, prolonged length of stay and increased mortality. The need for prompt assessment and early intervention for infection is widely recognized by Emergency Department staff as best practice, however, the average length of time to antibiotic administration varies widely in published studies.</p><p>Design: An interdisciplinary quality improvement initiative including physician, nursing, and pharmacy leaders was created to streamline the identification and treatment for this high-risk population. Based on published evidence for best practice and national recognition of the need for rapid treatment, the goal for administration of appropriate antibiotic therapy was changed to less than sixty minutes post Emergency Department arrival.</p><p>Setting: This project was conducted at two Emergency Departments in a pediatric healthcare system with 520 beds and a Level 1 and Level 2 trauma designation. Approximately 137,000 patients are seen annually. In the Emergency Departments, 271 staff members, including registered nurses, paramedics, and patient care technicians were educated about using the newly designed process.</p><p>Participants: Records from all patients with fever and a known history of pediatric cancer who presented to the Emergency Departments were included in the retrospective review. This included patients with solid tumors, acute lymphoblastic leukemia, acute myeloid leukemia, and chronic myelogenous leukemia. Exclusion criteria included patients in known remission, those with prior antibiotic therapy at another facility, congenital or drug induced neutropenia, or parental concern or objection to treatment.</p><p>Methods: A retrospective medical record review of febrile oncology patients treated from September 2008 until May 2012 was conducted to evaluate the impact of this evidence based practice change to streamline the "door to drug" process. The median length of time until antibiotic administration, and nurses' compliance initiating the protocol were determined.</p><p>Results/Outcomes: The review included 2,758 medical records. Over the study period from 2008 to 2012, one Emergency Department's median time for drug administration dropped from 106 to 39 minutes and the second dropped from 121 to 58 minutes, both below the 60 minute goal. Both campuses also improved their protocol compliance with Emergency Department 1 increasing from 24% to 78% and Emergency Department 2 improving from 30% to 84%. </p><p>Implications: This quality initiative has direct application for all Emergency Department leaders that treat pediatric oncology patients. High-risk patients can benefit from a streamlined nurse initiated process that decreases negative consequences of fever. Collaboration by interdisciplinary leadership within the healthcare facility as well as key stakeholder buy-in is imperative to achieve a process that may lead to decreased hospital stay, and reduced systemic infection or mortality for these vulnerable patients.</p>en_GB
dc.subjectPediatric Oncologyen_GB
dc.date.available2013-12-09T17:00:57Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:57Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationFt. Lauderdale, Florida, USAen_GB
dc.description2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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