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Saturday, 16 November 2013
Learning Objective 1: The learner will identify high-risk populations within their organization that could benefit from a streamlined process driven by nurse protocols.
Learning Objective 2: The learner will identify strategies to gain key stakeholder buy-in that will aid in the development and utilization of nurse driven protocols.
Infection is a frequent complication experienced by many pediatric patients with potentially life threatening consequences. The need for prompt assessment and early intervention for infection is widely recognized by Emergency Department (ED) staff as best practice, however, the average length of time to antibiotic administration varies widely in published studies. An interdisciplinary quality improvement initiative including physician, nursing, and pharmacy leaders was created to streamline the identification and treatment for these high-risk populations. This project was conducted at two EDs in a pediatric healthcare system with 520 beds who see approximately 154,000 patients annually. Records from all patients with fever and a known history of cancer and sickle cell disease who presented to the EDs were included in the retrospective review. Exclusion criteria included patients in known remission, those with prior antibiotic therapy at another facility, congenital neutropenia, or parental concern or objection to treatment. A retrospective medical record review of patients treated (5,559) from September 2008 until March 2013 was conducted to evaluate the impact of this evidence based practice change to streamline the "door to drug" process. The average length of time until antibiotic administration, nurses' compliance initiating the protocol, and ED length of stay were determined. Both ED's average time for drug administration dropped from 128 minutes to 50 minutes for oncology patients and from 78 to 44 minutes for sickle cell patients. Both campuses also improved their protocol compliance and decreased the overall ED length of stay. This quality initiative has direct application for all ED leaders who treat pediatric patients. High-risk patients can benefit from a streamlined nurse initiated process that decreases negative consequences of fever. Collaboration by interdisciplinary leadership within the healthcare facility as well as key stakeholder buy-in is imperative to achieve a process that may lead to decreased hospital stay and reduced systemic infection or mortality for these vulnerable patients.