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Projects and Initiatives, VA Northeast Ohio Healthcare System (VANEOHS) Febrile Neutropenic Protocol Update
BACKGROUND/PURPOSE
Febrile neutropenia (FN) is considered a life-threatening oncologic emergency that requires prompt recognition of the condition and expeditious administration of antibiotics. In 2021, a neutropenic workgroup in the VA Northeast Ohio Healthcare System (VANEOHS) began working on updating the neutropenic policy to match current neutropenic guidelines. In 2022, the policy was approved, and the following changes were implemented (1) timing of antibiotic administration changed from two hours to one hour of fever presentation (2) absolute neutrophil count (ANC) criteria changed from an ANC of ≤ 1.0 K/cmm to an ANC of ≤ 0.5 K/cmm or an ANC that is expected to decrease to ≤ 0.5 K/cmm during the next 48 hours.
SYNTHESIS OF LITERATURE
Each hour that antibiotics are delayed is associated with a decrease in survival and an increase in mortality of 7.6% (Koenig et al, 2019).
INTERVENTIONS
The existing neutropenic policy, order sets, and antibiogram were updated. The physicians, pharmacists, and nurses from the neutropenic workgroup conducted educational in-services with their respective groups. Badge backers were created for inpatient nursing staff to wear as a quick reference. Posters were hung in the medicine team workrooms. A protected health information (PHI) Outlook email was set up to automatically generate, notifying workgroup members when initial antibiotics are administered to a patient with neutropenic fever. This email allows “real time” tracking of initial antibiotic administration. A certificate of recognition was created to email to nurses who administer antibiotics within the 1-hour timeframe.
RESULTS
Monthly chart audits of timing from fever presentation to antibiotic administration are conducted. Data is reported monthly at the neutropenic workgroup meetings. The following data was gathered after implementation and shows gram negative antibiotic administration within one hour of fever presentation: September 2022, 100% (n = 1), October 2022, 100% (n = 1), November 2022, N/A (n = 0), December 2022, N/A (n = 0), January 2023, N/A (n = 0), February 2023, 100% (n = 1), March 2023, 100% (n = 1), and April 2023, N/A (n = 0).
IMPLICATIONS
Continue to monitor data to ensure targets are met and reevaluate process as needed.
BACKGROUND/PURPOSE
Febrile neutropenia (FN) is considered a life-threatening oncologic emergency that requires prompt recognition of the condition and expeditious administration of antibiotics. In 2021, a neutropenic workgroup in the VA Northeast Ohio Healthcare System (VANEOHS) began working on updating the neutropenic policy to match current neutropenic guidelines. In 2022, the policy was approved, and the following changes were implemented (1) timing of antibiotic administration changed from two hours to one hour of fever presentation (2) absolute neutrophil count (ANC) criteria changed from an ANC of ≤ 1.0 K/cmm to an ANC of ≤ 0.5 K/cmm or an ANC that is expected to decrease to ≤ 0.5 K/cmm during the next 48 hours.
SYNTHESIS OF LITERATURE
Each hour that antibiotics are delayed is associated with a decrease in survival and an increase in mortality of 7.6% (Koenig et al, 2019).
INTERVENTIONS
The existing neutropenic policy, order sets, and antibiogram were updated. The physicians, pharmacists, and nurses from the neutropenic workgroup conducted educational in-services with their respective groups. Badge backers were created for inpatient nursing staff to wear as a quick reference. Posters were hung in the medicine team workrooms. A protected health information (PHI) Outlook email was set up to automatically generate, notifying workgroup members when initial antibiotics are administered to a patient with neutropenic fever. This email allows “real time” tracking of initial antibiotic administration. A certificate of recognition was created to email to nurses who administer antibiotics within the 1-hour timeframe.
RESULTS
Monthly chart audits of timing from fever presentation to antibiotic administration are conducted. Data is reported monthly at the neutropenic workgroup meetings. The following data was gathered after implementation and shows gram negative antibiotic administration within one hour of fever presentation: September 2022, 100% (n = 1), October 2022, 100% (n = 1), November 2022, N/A (n = 0), December 2022, N/A (n = 0), January 2023, N/A (n = 0), February 2023, 100% (n = 1), March 2023, 100% (n = 1), and April 2023, N/A (n = 0).
IMPLICATIONS
Continue to monitor data to ensure targets are met and reevaluate process as needed.
BACKGROUND/PURPOSE
Febrile neutropenia (FN) is considered a life-threatening oncologic emergency that requires prompt recognition of the condition and expeditious administration of antibiotics. In 2021, a neutropenic workgroup in the VA Northeast Ohio Healthcare System (VANEOHS) began working on updating the neutropenic policy to match current neutropenic guidelines. In 2022, the policy was approved, and the following changes were implemented (1) timing of antibiotic administration changed from two hours to one hour of fever presentation (2) absolute neutrophil count (ANC) criteria changed from an ANC of ≤ 1.0 K/cmm to an ANC of ≤ 0.5 K/cmm or an ANC that is expected to decrease to ≤ 0.5 K/cmm during the next 48 hours.
SYNTHESIS OF LITERATURE
Each hour that antibiotics are delayed is associated with a decrease in survival and an increase in mortality of 7.6% (Koenig et al, 2019).
INTERVENTIONS
The existing neutropenic policy, order sets, and antibiogram were updated. The physicians, pharmacists, and nurses from the neutropenic workgroup conducted educational in-services with their respective groups. Badge backers were created for inpatient nursing staff to wear as a quick reference. Posters were hung in the medicine team workrooms. A protected health information (PHI) Outlook email was set up to automatically generate, notifying workgroup members when initial antibiotics are administered to a patient with neutropenic fever. This email allows “real time” tracking of initial antibiotic administration. A certificate of recognition was created to email to nurses who administer antibiotics within the 1-hour timeframe.
RESULTS
Monthly chart audits of timing from fever presentation to antibiotic administration are conducted. Data is reported monthly at the neutropenic workgroup meetings. The following data was gathered after implementation and shows gram negative antibiotic administration within one hour of fever presentation: September 2022, 100% (n = 1), October 2022, 100% (n = 1), November 2022, N/A (n = 0), December 2022, N/A (n = 0), January 2023, N/A (n = 0), February 2023, 100% (n = 1), March 2023, 100% (n = 1), and April 2023, N/A (n = 0).
IMPLICATIONS
Continue to monitor data to ensure targets are met and reevaluate process as needed.
Improving Ototoxicity Monitoring with Cisplatin Therapy at VA Northeast Ohio Healthcare System (VANOHS), An Interdisciplinary Team Approach
BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.
RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.
INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.
BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.
RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.
INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.
BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.
RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.
INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.