QI initiatives improve antibiotic initiation in bone marrow transplant patients

1. Increased education and process standardization led to a significant decrease in time to antibiotic administration among inpatient bone marrow transplant (BMT) pediatric patients with a new fever.

2. Proportion of BMT patients who received antibiotics within 60 minutes of first fever more than doubled after QI interventions were implemented.

Study Rundown: Septicemia, frequently presenting as fever, is a common source of morbidity, mortality, prolonged hospitalization, and increased resource utilization among pediatric patients with bone marrow transplant (BMT). Early antibiotic administration (within 60 minutes of sepsis recognition) has been linked to improved outcomes in patients with blood stream infections. In this initiative, investigators aimed to reduce time to antibiotic administration to <60 minutes among hospitalized BMT patients with first fever. Results showed mean time to antibiotic administration improved steadily throughout the study period (2014-2017). Variability in administration time also decreased, and the proportion of patients who received antibiotics within 60 minutes more than doubled. This small sample size limited evaluation of intervention effect on outcomes such as length of hospital stay or care resource utilization. While follow-up studies are needed to determine long-term effects, these initial results suggest that improvements in antibiotic administration may be attained with QI initiatives.

Click to read the study, published today in Pediatrics

Relevant reading: Trends in the epidemiology of pediatric severe sepsis

In-depth [QI initiative]: Members of a multidisciplinary improvement team at Cincinnati Children’s Hospital Medical Center used a series of plan-do-study-act (PDSA) cycles to improve antibiotic initiation to <60 minutes among bone marrow transplant with first fever (patients with temperature >38 C not currently on treatment dose antibiotics). They reviewed patient charts from 2014-2015 to obtain baseline time data and identify key areas for improvement. Interventions included creation of standardized processes to ensure all team members were notified of a patient’s first fever, development of a specific order set for first fever, and creation of protocols to improve antibiotic delivery from pharmacy to bedside nurse. Changes were implemented gradually from 2015 to 2017, with frequent feedback to team members and adjustments to workflows. A total of 650 BMT patients with first fever were included in the analysis from 2014-2017. Results showed the mean time to antibiotic administration decreased from 75 minutes to 52 minutes after the first intervention in 2015, and to 45 minutes by the end of 2016. Variability in time to antibiotic initiation also decreased from a standard deviation of +/-75 minutes to +/-19 minutes and +/-10 minutes, after first intervention and at study end, respectively. The proportion of patients receiving antibiotics within 60 minutes of first fever identification improved from 40% to 95% at the end of the study period.

Image: PD

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