Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia.
OBJECTIVE
To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia.


METHODS
Practice change.


METHODS
The oncology unit of an urban hospital in the south-eastern United States.


METHODS
Adult patients with cancer and febrile neutropenia admitted six months prior to (n = 30) or during the three months following (n = 23) implementation of the order set.


METHODS
Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Time intervals were analyzed using SPSS® software, version 18.


METHODS
Initial antibiotic times, order-set use, and length of stay.


RESULTS
An overall reduction in time intervals for initiation of antibiotic therapy was observed for presentation (t = 2.25; degrees of freedom [df] = 37; p = 0.031) and order (t = 2.67; df = 40.17; p = 0.012) to antibiotic administration, with an order-set usage of 31% in the inpatient unit and 71% in the emergency department.


CONCLUSIONS
Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit-based medication dispensing machines helped reduce time intervals for initial antibiotic therapy.


CONCLUSIONS
The use of an evidence-based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence-based practice changes.
Presbyterian School of Nursing, Queens University of Charlotte, North Carolina, USA. bestj@queens.edu
Janie T
JT
Best
Karen
K
Frith
Faye
F
Anderson
Carla Gene
CG
Rapp
Lisa
L
Rioux
Christina
C
Ciccarello
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy*; D016522:Oncology Service, Hospital / Q000458:organization & administration*; D012189:Retrospective Studies; D015144:Southeastern United States; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents