McKinney Christopher, Caruso-Brown Amy, Montgomery Kathleen, Gillespie Anne, Coughlin Rebecca, Law Dawn, Brouwer Anna, Tytler Lauren, Hilden Joanne, Nuss Rachelle
Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.
Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
Pediatr Qual Saf. 2020 Jan 10;5(1):e245. doi: 10.1097/pq9.0000000000000245. eCollection 2020 Jan-Feb.
Children with sickle cell disease (SCD) are at increased risk for sepsis secondary to functional asplenia. Timely administration of antibiotics, within 60 minutes of triage, is a national indicator of quality SCD care in the United States. However, there are no reports demonstrating the feasibility of doing so in the outpatient hematology-oncology clinic setting.
At baseline, in our pediatric hematology-oncology outpatient center, just 10% of children with SCD and fever received timely antibiotics.
We implemented a process improvement initiative for children with SCD and fever with the aim of ≥90% receiving timely antibiotics. We enacted interventions focused on general clinic processes from check-in to antibiotics and population-specific interventions, including an intravenous access protocol, notification/communication among staff members, and design of an electronic order set.
The percentage of children receiving timely antibiotics improved from 10% to 77% with successful maintenance following the interventions. Residual delays are due to nonexpeditious order placement and difficult intravenous access.
Improving the timely administration of antibiotics in the outpatient hematology-oncology clinic setting for children with SCD and fever is possible. Achieving at least 90% timely antibiotics for children with SCD and fever in the outpatient clinic setting will require ongoing efforts at expeditious order placement and intravenous access.
镰状细胞病（SCD）患儿因功能性无脾而发生败血症的风险增加。在美国，在分诊后60分钟内及时使用抗生素是优质SCD护理的一项全国性指标。然而，尚无报告表明在门诊血液肿瘤诊所环境中这样做的可行性。
在基线时，在我们的儿科血液肿瘤门诊中心，只有10%的SCD发热患儿及时接受了抗生素治疗。
我们针对SCD发热患儿实施了一项流程改进计划，目标是≥90%的患儿能及时接受抗生素治疗。我们制定了干预措施，重点关注从登记到使用抗生素的一般诊所流程以及针对特定人群的干预措施，包括静脉通路方案、工作人员之间的通知/沟通以及电子医嘱集的设计。
接受及时抗生素治疗的患儿比例从10%提高到了77%，干预后成功维持了这一比例。剩余延迟是由于医嘱下达不及时和静脉通路困难。
在门诊血液肿瘤诊所环境中提高SCD发热患儿抗生素的及时使用是可行的。要在门诊环境中使至少90%的SCD发热患儿及时使用抗生素，将需要持续努力以加快医嘱下达和建立静脉通路。
