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Early recognition and treatment of febrile neutropenia in a community hospital.

90 Background: Febrile neutropenia (FN) is a medical emergency leading to significant morbidity if unrecognized. The use of G-CSF has made FN a less frequent presentation to community hospitals. Significant delays in antibiotic initiation were seen in our community hospital system. Antibiotic selection was variable and blood cultures were often not obtained prior to antibiotics. In November 2011, a FN program was initiated to increase recognition of patients at risk for FN, reduce time to antibiotic initiation, improve antibiotic selection using guideline driven antibiotic (GDA) selection, and decrease morbidity.


METHODS
A FN Card was developed providing a link to the hospital website detailing the approach to FN, obtaining blood cultures, and use of GDA for patients with or without venous access devices. Patients were educated to carry the card with them and present the card to the triage nurse on ER arrival if their home temperature was over 100.4F. A nurse driven protocol was developed for assessment, blood cultures, and early initiation of GDA and an educational program was provided to the ER staffs at all hospitals in our system.


RESULTS
In the 6 month lead up to the initiation of the FN program, 31 patients were identified with FN; 22 as the result of malignancy or therapy, 9 because of benign disease. The median time to antibiotics was 6.3 hours, no patient received GDA, and 32% had blood cultures performed. Three months after initiation of the program, 26 patients presented to the ERs over a 12-week period; 20 from malignant disease or its therapy, 6 from benign disease. Seven patients had received a FN card in clinic and 2 presented the card to the ER triage nurse. Median time to GDA was 2 hours and all 26 patients received GDA, 22 patients (85%) had blood cultures performed prior to GDA.


CONCLUSIONS
A FN educational program including a FN Card linked to the hospital web site resulted in a significant increase in the number of patients recognized early presenting with FN, reduced time to antibiotic initiation, improved GDA selection and improved blood culture rates before GDA. Data regarding reducing morbidity are pending.