Burns Beech, Hartenstein Melinda, Lin Amber, Langley Denise, Burns Erin, Heilman James, Tanski Mary, Stork Linda, Ma O John
Department of Emergency Medicine, Oregon Health and Science University, Portland, Ore.
Department of Pediatric Critical Care, Oregon Health and Science University, Portland, Ore.
Pediatr Qual Saf. 2019 Nov 21;4(6):e236. doi: 10.1097/pq9.0000000000000236. eCollection 2019 Nov-Dec.
Febrile neutropenia is a potentially life-threatening complication of chemotherapy in pediatric oncology patients. Prompt initiation of antibiotic therapy may minimize morbidity and mortality associated with this condition, and time to antibiotic (TTA) administration <60 minutes is used as a quality benchmark by many institutions. We implemented a quality improvement initiative to achieve TTA < 60 minutes in >80% of eligible patients in the pediatric emergency department.
After collecting baseline data, we employed consecutive PDSA cycles to (i) reduce time to antibiotic order after patient arrival; (ii) expedite the preparation of antibiotic by pharmacy; and (iii) enable antibiotic ordering before patient arrival. Statistical process control methodologies were used for key outcome measures to compare pre-intervention, post-intervention, and maintenance periods.
Comparing pre-intervention and post-intervention years, mean TTA decreased from 64 to 53 minutes and the percentage of patients receiving antibiotics in <60 minutes increased from 59% to 84%. Improvements were sustained in the maintenance period of the project, with mean TTA administration of 44 minutes and 85% of patients receiving antibiotics within our stated goal.
Through a series of PDSA cycles, we decreased TTA and increased the percentage of febrile neutropenia patients receiving antibiotics in <60 minutes.
发热性中性粒细胞减少是儿科肿瘤患者化疗的一种潜在危及生命的并发症。及时开始抗生素治疗可将与此病症相关的发病率和死亡率降至最低，许多机构将抗生素给药时间（TTA）<60分钟用作质量基准。我们实施了一项质量改进计划，以使儿科急诊科中超过80%的符合条件患者的TTA<60分钟。
收集基线数据后，我们采用连续的计划-执行-检查-处理（PDSA）循环来：（i）减少患者到达后下达抗生素医嘱的时间；（ii）加快药房准备抗生素的速度；（iii）在患者到达前即可下达抗生素医嘱。使用统计过程控制方法对关键结果指标进行比较，以对比干预前、干预后和维持期。
比较干预前和干预后的年份，平均TTA从64分钟降至53分钟，在<60分钟内接受抗生素治疗的患者百分比从59%增至84%。在项目的维持期，改进得以持续，平均TTA给药时间为44分钟，85%的患者在我们设定的目标时间内接受了抗生素治疗。
通过一系列PDSA循环，我们缩短了TTA，并提高了发热性中性粒细胞减少患者在<60分钟内接受抗生素治疗的百分比。
