Two Posters Seek to Spread the Word on Febrile Neutropenia

Both posters noted that although the literature contains abundant information on febrile neutropenia, which is considered an oncologic emergency, providers unfamiliar with oncology, such as those working in the emergency department or in primary care, often fail to promptly recognize this chemotherapeutic complication, resulting in treatment delays, increased length of hospital stay, and decreased quality of life.

Princeton Strategies

The Princeton nurses sought to increase early assessment and treatment of febrile neutropenia by improving patient education and increasing access to evidence-based care. The nurses began by assessing the incidence of febrile neutropenia by conducting a literature review and then auditing charts from patients treated with chemotherapy at their institution between November 1, 2008 and February 27, 2009. They found an incidence of 7% (12 of 170 chart) at their institution, and while this number is not high, the records showed that patient education on the matter was lacking. To tackle this issue, the nurses developed an education sheet on febrile neutropenia, which was incorporated into their institution’s online patient education database, a resource accessible to all depatments. In addition, they created a “chemo card,” which patients can carry in their wallets. The card provides patients with important information regarding neutropenia, including what it is how to minimize risk of infection, and when to seek assistance. Finally, the nurses developed a protocol for nurses working outside the oncology unit to assist them with managing these patients. This protocol, which includes guidance on patient assessment, treatment, time parameters, and patient education, is currently undergoing review. It is anticipated that these strategies will help improve the care of patients presenting with febrile neutropenia.

Trinitas Strategies

Oncology nurses at Trinitas sought to increase awareness of febrile neutropenia at their institution by educating departments that might be involved in assessing or identifying patients presenting with this disorder, including the emergency department, pharmacy, infection control, and in-patient units. They also sought to raise awareness of febrile neutropenia among patients receiving chemotherapy by educating them on complete blood counts, while blood cell counts, and absolute neutrophil counts. They have also instructed patients to request copies of their blood work at each visit, informed them on what to do in the event of febrile episodes, and have guided them on how to protect themselves from this potentially fatal complication. In addition, an emergency department standard order set was developed, which is being expanded into an inpatient standard order set, and neutropenic precautions were modified to reflect evidence-based practice. The team’s ultimate objective is to deliver the first antibiotic dose within 1 hour of patient presentation. To determine if they can meet this goal, they will evaluate all oncologic patients presenting to the hospital with febrile neutropenia, taking note of response times in both the emergency department and the time it took from pharmacy orders to the first infusion.

Question for the reader

Are any steps being taken at your institution to educate patients on febrile neutropenia? Post your comment below or send an e-mail to cloguidice@onclive.com.

During the Oncology Nursing Society (ONS) 35th Annual Congress, two similarly titled posters were presented, both of which sought to raise awareness of febrile neutropenia and improve the care of patients who develop it. The first poster was presented by nurses from University Medical Center at Princeton and Princeton Healthcare Medical Associates, Princeton, New Jersey, whereas the second was presented by nurses from Trinitas Comprehensive Cancer Center, Elizabeth, New Jersey.