提高潜在中性粒细胞减少的发热儿科患者使用抗生素及时性的质量改进计划。
Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia.
作者信息
Monroe Kathy, Cohen Clay T, Whelan Kimberly, King Amber, Maloney Lisa, Deason Janet, Nichols John Charles, Friedman Gregory K, Kutny Matthew, Hayes Leslie
机构信息
Department of Pediatrics, Division of Emergency Medicine, Pediatric Emergency Medicine, University of Alabama, Birmingham, Ala.
Department of Pediatrics, Division of Hematology, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Tex.
出版信息
Pediatr Qual Saf. 2018 Aug 9;3(4):e095. doi: 10.1097/pq9.0000000000000095. eCollection 2018 Jul-Aug.
INTRODUCTION
In patients who are immunocompromised, fever may indicate a life-threatening infection. Prompt time to antibiotic administration in febrile patients at risk for neutropenia has been identified by national and international panels as a key benchmark of quality care in emergent situations. A quality improvement initiative to improve health care provided in a pediatric emergency department (ED) is described.
METHODS
A clinical pathway was previously initiated in a pediatric ED with a goal of improving time to antibiotics for febrile neutropenia patients. An agreed upon pathway and order set being initiated. Improvements were seen but not to the desired level. This project involved an improvement cycle that focused on nonvalue added time in the workflow.
RESULTS
Percent of patients receiving antibiotics within the goal time of 1 hour increased from 40% to 80% with the intervention. Process measures including arrival to ED bed time, ED bed to antibiotic order time and antibiotic order time to delivery time were followed.
CONCLUSION
Clinical guidelines, order sets and detailed understanding of the actual workflow at the point of care delivery can be instrumental in achieving the goals of reducing time to antibiotics.
引言
在免疫功能低下的患者中，发热可能表明存在危及生命的感染。国家和国际专家组已确定，对于有中性粒细胞减少风险的发热患者，及时给予抗生素治疗是紧急情况下优质医疗护理的一项关键基准。本文描述了一项旨在改善儿科急诊科（ED）医疗服务的质量改进举措。
方法
此前在一家儿科急诊科启动了一条临床路径，目标是缩短发热性中性粒细胞减少症患者使用抗生素的时间。当时启动了一个商定好的路径和医嘱集。虽然有改善，但未达到预期水平。该项目涉及一个改进周期，重点关注工作流程中无增值的时间。
结果
通过干预，在1小时目标时间内接受抗生素治疗的患者比例从４０％提高到了８０％。对包括到达急诊科病床时间、从急诊科病床到开出抗生素医嘱时间以及从开出抗生素医嘱到给药时间等流程指标进行了跟踪。
结论
临床指南、医嘱集以及对护理点实际工作流程的详细了解，有助于实现缩短使用抗生素时间的目标。
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