A nurse-led protocol improves the time to first dose intravenous antibiotics in septic patients post chemotherapy

Abstract

Purpose: Neutropenic sepsis is a time-dependent emergency with early interventions shown to improve outcomes. Broad spectrum intravenous antibiotic administration is the initial therapy in patients with suspected neutropenic sepsis. Compliance with early antibiotic administration in febrile neutropenia patients is poor. Innovations have been trialled to improve the time to first dose intravenous antibiotics in patients with suspected neutropenic sepsis. Consideration of extending first dose intravenous antibiotic prescribing to trained nursing staff may improve performance in this key standard.

Methods: A retrospective analysis was performed at a specialist oncology hospital in the North West of England from January 1st 2015 to January 31st 2016. The nurses on the Medical Admissions Unit (MAU) have been given the responsibility of assessing patients presenting with fever post chemotherapy including prescribing and administering the first dose of intravenous antibiotics with the aim of improving the speed of this intervention.

Results: During the study period, 697 patients presented to the MAU with suspected sepsis post chemotherapy. Six hundred seventy-two (96.4 %) patients received their first dose of intravenous antibiotics within 60 min of presentation to the MAU. Of this group, 323 (48.1 %) were administered antibiotics within 15 min of arrival. Of the 25 (3.6 %) patients who did not receive antibiotics within 1 h, root cause analysis revealed the reason in 23 (92 %) patients was an inability to ascertain intravenous access.

Conclusion: Nurse-led protocols are an effective, safe, and sustainable method for achieving early antibiotic administration in patients with suspected febrile neutropenia. This is a key component of ensuring improved outcomes for this cohort of patients.

Keywords: Chemotherapy; Neutropenia; Nurse-led; Sepsis; Time to antibiotics.