title: Febrile neutropenia risk assessment tool: improving clinical outcomes for oncology patients.
abstract: OBJECTIVE
  To develop, implement and evaluate the effectiveness of a nurse-led risk assessment tool to reduce the incidence of febrile neutropenia (FN) and evaluate the nurse's role in FN risk assessment in a hospital-based oncology unit.
  
  
  METHODS
  A FN risk assessment tool was developed, implemented and evaluated. A comparative prospective observational chart review was undertaken to evaluate the tool. Clinical data were collected from 459 patients' records from August 2008 through July 2009. Patients had no intervention during the first six months (n = 233). Patients in the following six months (n = 226) had the FN risk assessment completed and appropriate granulocyte-colony stimulating factor prescribed. A self-questionnaire was utilised to evaluate the nurses' role in FN risk assessment.
  
  
  RESULTS
  The incidence of FN was reduced by 52% (p = 0.02). Hospital days, dose reductions and treatment delays were reduced. Nurses felt they were the most appropriate person to carry out the assessment.
  
  
  CONCLUSIONS
  Through consistent risk assessment, nurses could determine which patients were at high risk of developing FN leading to significant reduction in life-threatening infections, hospitalisations, dose reductions and delays. Nurses can be confident and competent in decision-making to reduce life-threatening infections through the use of an FN risk assessment tool.
authors.affiliation: Haematology Oncology Department, HOPE Directorate, St James's Hospital, James's Street, Dublin 8, Ireland. Electronic address: caobrien@stjames.ie.
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland. Electronic address: odempsey@tcd.ie.
authors.forename: Orla
authors.initials: O
authors.lastname: Dempsey
authors.affiliation: Haematology Oncology Department, HOPE Directorate, St James's Hospital, James's Street, Dublin 8, Ireland; Academic Unit of Clinical and Molecular Oncology, Trinity College Dublin, Ireland. Electronic address: jkennedy@stjames.ie.
authors.forename: M John
authors.initials: MJ
authors.lastname: Kennedy
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002173:Cancer Care Facilities; D064147:Febrile Neutropenia / Q000209:etiology* / Q000451:nursing* / Q000628:therapy; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007494:Ireland; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing; D009730:Nursing Assessment; D009859:Oncology Nursing / Q000458:organization & administration*; D010865:Pilot Projects; D011361:Professional Competence; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Chemotherapy; Febrile neutropenia; G-CSF; Risk assessment; Risk factors