514793
research-article2013
JPOXXX10.1177/1043454213514793Journal of Pediatric Oncology Nursing XX(X)Cox and Bradford
Article
Management of Febrile Neutropenia in Pediatric Oncology Across Queensland, Australia: A Retrospective Review on Variations Between Locations
Journal of Pediatric Oncology Nursing 2014, Vol. 31(1) 28–33 © 2013 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454213514793 jpo.sagepub.com
Anita Cox, BSc (Hons), RGN, RSCN, Dip (ANC Pediatric Oncology)1, and Natalie Bradford, RN, BNursing, MPH2
Abstract Febrile neutropenia (FN) is a common complication in pediatric oncology with intravenous antibiotics being given routinely for decades. This study aimed to compare the management of FN in children in different locations across Queensland, Australia. FN episodes were identified from 4 settings: tertiary oncology outpatient department (OD), tertiary emergency department (ED), regional ward (RW), and regional emergency department (RED) between July 2009 and June 2011. Retrospective data were extracted from medical records, collated, and then analyzed to identify differences in outcomes attributable to location. Sixty-one episodes of FN were reviewed: 5 cases from OD, 28 from ED, 19 from RW, and 5 from RED. Statistically significant differences occurred in the time taken for medical review for cases depending on location of presentation. Patients who presented to the ED or the RW were more likely to be seen within 30 minutes than in other locations (P = .014), and patients who presented to the tertiary hospital in either the OD or ED were more likely to commence antibiotics within 120 minutes of presentation (P = .023). Antibiotics were commenced within 60 minutes (the gold standard) on only 10 occasions. Despite education input emphasizing the importance of early commencement of antibiotics, this study identified that this objective was not met in the majority of cases. Further study is needed to look at reasons for the delay in beginning treatment for pediatric oncology patients in Queensland and what measures may assist with improving the time from presentation with FN to antibiotic administration across all settings. Keywords febrile neutropenia, Pediatric oncology, patient management
Background Febrile neutropenia (FN) is a common complication in patients undergoing chemotherapy to treat cancer. It remains the most common cause of nonplanned hospitalization, occurring at unpredictable times during the patients’ treatment regime (Lyman et al., 2010; Segel & Halterman, 2008). Definitions of both fever and neutropenia differ across the oncology supportive care literature; however, general consensus defines fever as greater than 38.5°C on 1 occasion, or greater than 38°C on 2 occasions less than an hour apart, and neutropenia as an absolute neutrophil count of
research-article2013
JPOXXX10.1177/1043454213514793Journal of Pediatric Oncology Nursing XX(X)Cox and Bradford
Article
Management of Febrile Neutropenia in Pediatric Oncology Across Queensland, Australia: A Retrospective Review on Variations Between Locations
Journal of Pediatric Oncology Nursing 2014, Vol. 31(1) 28–33 © 2013 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454213514793 jpo.sagepub.com
Anita Cox, BSc (Hons), RGN, RSCN, Dip (ANC Pediatric Oncology)1, and Natalie Bradford, RN, BNursing, MPH2
Abstract Febrile neutropenia (FN) is a common complication in pediatric oncology with intravenous antibiotics being given routinely for decades. This study aimed to compare the management of FN in children in different locations across Queensland, Australia. FN episodes were identified from 4 settings: tertiary oncology outpatient department (OD), tertiary emergency department (ED), regional ward (RW), and regional emergency department (RED) between July 2009 and June 2011. Retrospective data were extracted from medical records, collated, and then analyzed to identify differences in outcomes attributable to location. Sixty-one episodes of FN were reviewed: 5 cases from OD, 28 from ED, 19 from RW, and 5 from RED. Statistically significant differences occurred in the time taken for medical review for cases depending on location of presentation. Patients who presented to the ED or the RW were more likely to be seen within 30 minutes than in other locations (P = .014), and patients who presented to the tertiary hospital in either the OD or ED were more likely to commence antibiotics within 120 minutes of presentation (P = .023). Antibiotics were commenced within 60 minutes (the gold standard) on only 10 occasions. Despite education input emphasizing the importance of early commencement of antibiotics, this study identified that this objective was not met in the majority of cases. Further study is needed to look at reasons for the delay in beginning treatment for pediatric oncology patients in Queensland and what measures may assist with improving the time from presentation with FN to antibiotic administration across all settings. Keywords febrile neutropenia, Pediatric oncology, patient management
Background Febrile neutropenia (FN) is a common complication in patients undergoing chemotherapy to treat cancer. It remains the most common cause of nonplanned hospitalization, occurring at unpredictable times during the patients’ treatment regime (Lyman et al., 2010; Segel & Halterman, 2008). Definitions of both fever and neutropenia differ across the oncology supportive care literature; however, general consensus defines fever as greater than 38.5°C on 1 occasion, or greater than 38°C on 2 occasions less than an hour apart, and neutropenia as an absolute neutrophil count of
