Children's Hospital and Medical Center, Omaha, NE, United States of America.
Children's Hospital and Medical Center, Omaha, NE, United States of America.
J Pediatr Nurs. 2019 May-Jun;46:78-82. doi: 10.1016/j.pedn.2019.02.028. Epub 2019 Mar 8.
For patients with chemotherapy-induced neutropenia and fever, delays in antibiotic administration are associated with poor outcomes, such as ICU admission and need for further interventions. 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.
An interdisciplinary team set an evidence-based goal for time to antibiotics (TTA) at 60-min. A six-month retrospective chart review of Emergency Department (ED) patients revealed a 128 min TTA mean when measured from the initiation of triage to antibiotic administration, which also reflected 0% of patients receiving antibiotics within the goal of 60 min. Members of the interdisciplinary team evaluated delays in patient care workflow and identified three primary interventions to decrease the TTA. These three evidenced-based interventions were implemented and evaluated using the Plan-Do-Check-Act (PDCA) quality improvement methodology.
By the end of the implementation period mean TTA improved to 53 min and patients received antibiotics within 60 min (83% of the time).
The interventions focused on both provider and nursing workflow, however the implementation of an evidence-based practice nursing order set made the greatest impact on timeliness of antibiotic delivery time.
对于因化疗引起的中性粒细胞减少和发热的患者，抗生素给药的延迟与不良结局相关，例如入住 ICU 和需要进一步干预。本质量改进项目的目的是显著缩短因中性粒细胞减少和发热而到急诊科就诊的儿科患者从分诊开始到给予抗生素治疗的时间。
一个跨学科团队为抗生素治疗时间（TTA）设定了一个基于证据的目标，即 60 分钟。对急诊科（ED）患者进行了六个月的回顾性图表审查，结果显示，从分诊开始到抗生素治疗的 TTA 平均为 128 分钟，这也反映了 0%的患者在 60 分钟的目标内接受了抗生素治疗。跨学科团队成员评估了患者护理工作流程中的延迟，并确定了减少 TTA 的三个主要干预措施。这三个基于证据的干预措施使用计划-执行-检查-行动（PDCA）质量改进方法进行了实施和评估。
在实施期间结束时，平均 TTA 改善至 53 分钟，并且 83%的患者在 60 分钟内接受了抗生素治疗。
干预措施既关注提供者，也关注护理工作流程，但实施基于证据的实践护理医嘱集对提高抗生素给药及时性产生了最大的影响。
