American Academy of Physician Assistants (AAPA) IMPACT 2012 National Conference
Background: Infection is a complication in patients receiving treatment for cancer that results in an increase in morbidity and mortality. One of the contributing factors to the development of infection is treatment induced neutropenia. The promptness of treatment of cancer patients with an infection is imperative as greater than 50% of patients with severe neutropenia will die if untreated during the first 48 hours of infection. The purpose of this study was to analyze the relationship between infection and timeliness of antibiotic administration in neutropenic cancer patients with stratification based on admission status, caregiver characteristics and ordered blood cultures.
Methods: This study was a retrospective study which involved a medical record review of hospitalized oncology patients diagnosed with neutropenia during the months of July through December of 2008. Information obtained from the medical record included: admission status (admission through the emergency department, inpatient, and direct admission), laboratory values (WBC, ANC, and blood cultures), antibiotic information, clinical presentation (temperature and sepsis parameters), medical co-morbidities, and nurse characteristics. In addition, a survey was sent to all nurses who were involved in the care of cancer patients. The survey requested information regarding educational status, oncology certification, and years of experience.
Results: 106 patients and seventy-six nurses were identified in the six month period. After analysis, it was found that forty-four patients received antibiotics before presentation of their fever. Leaving sixty-two patients with seven corresponding nurses with survey information pertaining to certification, experience, and education status. There was no statistical significant difference in time of fever to antibiotic admission when stratified by admission status (p= 0.561), blood cultures (p=0.338), and oncology certification status (p=0.934). Time frame for antibiotic administration is as follows: fever to physician notification (n=11), range 0-510 minutes, and standard deviation of 175.18; physician notification to antibiotic order (n=62), range 0-6897 minutes and, standard deviation of 885.76; finally antibiotic order to antibiotic administration (n=62), range 0-1445 minutes, and standard deviation of 192.88. 95.2% of the sample presented with severe neutropenia, defined as an ANC, 1500 microL.
Conclusions: The findings of this research indicate that there is no significance between antibiotic timeliness and admission status, blood cultures, and oncology certification status. The most influential time frame (greatest time frame in fever to antibiotic admission) is time between physician notification and antibiotic order with a 0-6897 minute range, or almost five days. Antibiotic administration timeliness for severity of infection dependent on ANC levels is not predictable in this study as 95.2%, have severe neutropenia. Finally, due to the low return from nurses who cared for these patients (n=7) there is no significance between years of nursing experience, years of oncology experience, nursing education, oncology certification and timeliness of antibiotic administration.