A centre specific Quality Improvement Project (QIP) to decrease ‘temperature spike to needle time’ for first dose empiric antibiotics to within 60 minutes for inpatients in a haematology and autologous stem cell transplant unit within a UK District General Hospital

Leloch, Daniella; Armoogum, Julie; Ponsford, Allison

Abstract

Background

Neutropenic sepsis following systemic anti-cancer therapy and autologous stem cell transplant is a life-threatening emergency, with a mortality rate of 40% among haematology patients (Klastersky et al 2016, NICE 2024), due to deeper and prolonged immunosuppression and the direct influence of haematological malignancies on bone marrow cell production (White and Ybarra, 2017). Neutropenic sepsis is defined as:

· a neutrophil count of 0.5x109 per litre or lower, with a temperature of 38°C or higher or signs and symptoms consistent with clinical sepsis and national clinical guidance stipulates prompt diagnosis and management of neutropenic sepsis.

To reduce morbidity and mortality (The National Institute for Health and Care Excellence, NICE 2012) recommend that intravenous antibiotics (IVAB) should be administered within 60 minutes of a temperature spike above 38°C (NICE, 2012).

Aim: To decrease ‘temperature spike to needle time’ for first dose empiric antibiotics to within 60 minutes for 50% of Haematology inpatients on the Haematology/autologous transplant unit within 6 months.

Methods

Multiple interventions were identified, developed and implemented to decrease ‘temperature spike to needle time’ including: a targeted teaching programme, electronic Future Use Prescriptions, a clinical algorithm to support decision making and a Standard Operating Procedure. ‘Temperature spike to needle time’ audit data was collected at baseline and six months later. Numerous cycles of the Plan, Do, Study Act (PDSA) model supported this QIP.

Results

Sixteen patients were identified in the baseline audit, 25% of these received autologous stem cell transplants. Fourteen patients spiked a temperature and only two of these neutropenic patients (14.3%) received IVABs within 60 minutes in line with the national standard. Temperature spike to prescription time ranged from 1 minute to 1,323 minutes, with an average of 219 minutes (3.6 hours). Temperature spike to administration of first dose IVAB ranged from 40 minutes to 1987 minutes, with an average of 446 minutes (7.43 hours).

Following the interventions, the audit at six months found, of the seven patients with neutropenia who experienced a temperature spike, four patients received IVABs within 60 minutes (57.1%). This represented a 42.8% improvement compared to baseline. Temperature spike to prescription time was reduced by 50% (219 minutes to 105 minutes). Temperature spike to administration time was reduced from 446 minutes to 136 minutes.

Conclusion

Implementing these interventions resulted in a 42.8% improvement in ‘temperature spike to needle time’ for first dose empiric antibiotics on the inpatient haematology ward. Challenges identified include the inconsistent prescribing of the Future Use Prescriptions. There is a need to increase engagement and collaboration with key stakeholders to develop momentum, confidence and consistency towards embedding this practice change. This improvement in safe clinical practice for autologous transplant patients promotes the safe clinical management of allogeneic and CAR-T transplant patients repatriated to the Haematology service within a District General Hospital setting.

References:

Klastersky, J., de Naurois, J., Rolston, K., et al. (2016) Management of febrile neutropaenia: ESMO clinical practice guidelines. Annals of Oncology 27(S5), 111-118.

National Institute for Health and Care Excellence (2024) Neutropenic Sepsis. Accessed: https://cks.nice.org.uk/topics/neutropenic-sepsis/

Neutropenic sepsis: prevention and management in people with cancer. Clinical Guideline [CG151]. Published: 19 September 2012 & Updated January 2020. Available from: www.nice.org.uk.

White, L. and Ybarra, M. (2017) Neutropenic Fever. Haematology/Oncology Clinics of North America. [Online]. 31 (6), pp. 981-993



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• Presentation Conference Type: Conference Abstract
• Conference Name: EMBT
• Start Date: Mar 30, 2025
• End Date: Apr 2, 2025
• Acceptance Date: Mar 10, 2025
• Deposit Date: Mar 11, 2025
• Peer Reviewed: Not Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/13929625