Vanderway, J., Vincent, C., Walsh, S.M., & Obrecht, J. (2017). Implementation of a pathway for the treatment of fever and neutropenia in pediatric patients with cancer. Journal of Pediatric Oncology, 34, 315–321.

Implement a pathway to achieve Time To Antibiotics (TTA) in less than 60 minutes form presentation for outpatient evaluation of FN in pediatric patients with cancer. Other endpoint was to improve bedside nurses’ understanding of fever, neutropenia, and importance of Rapid Time To Antibiotics (RTTA).

Implementation of Clinical Pathway for RTTA in less than 60 minutes

Inservice and poster board used to educate nurses about fever and neutropenia. Knowledge measured with pre- and post-tests.

• N: 25 patients and 12 nurses
• AGE: From birth to age 18 years
• MALES: Not reported  
• FEMALES: Not reported
• CURRENT TREATMENT: Combination radiation and chemotherapy
• KEY DISEASE CHARACTERISTICS: Pediatric oncology patients in the Ambulatory Infusion Center with fever and neutropenia receiving antibiotics.  Patients without implanted vascular access devices were excluded.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: University of Chicago

• PHASE OF CARE: Active anti-tumor treatment
• APPLICATIONS: Pediatrics

TTA was tracked using retrospective chart review to determine pre-pathway metrics.

Retrospective chart review using electronic health record filters was used for pre-pathway data collection. A computerized spreadsheet was used for post-pathway data collection.

Nursing knowledge was tested using a 9-item Fever and Neutropenia Questionaire. A bulletin board with key FN concepts and an in-service by APNs were sources of education.

Nurses had a mean score of 7.5 correct answers for the pre-education questionnaire and an 8.92 mean score for post-education (p = 0.0002).

Improvement in nurses knowledge of FN was improved with education and TTA was improved with a clinical pathway. The study included a very small sample of pediatric patients and nurses from one cancer center, resulting in limited application to other settings.

• Small sample (< 30)
• Measurement validity/reliability questionable 
• Findings not generalizable

Based on literature review and limited findings of this QI project, clinical pathways and nursing education are successful ways to improve care of patients with FN. Recommendations for implementing in other settings will need larger studies demonstrating success with these interventions to demonstrate applicability.