Decreasing ‘temperature spike to needle time’ for first dose empiric antibiotics to within 60 minutes within a haematology inpatient setting

Ponsford, Allison; Leloch, Daniella; Armoogum, Julie

Abstract

Title: Quality Improvement Project to decrease the ‘temperature spike to needle time’ for first dose empiric antibiotics to within 60 minutes within a haematology inpatient setting.

Background: Neutropenic sepsis following systemic anti-cancer therapy is a serious and life-threatening emergency. Local and National clinical guidance stipulates prompt diagnosis and management of neutropenic sepsis is critical to reduce morbidity and mortality (Perron, Emara and Ahmed, 2014). Intravenous antibiotics (ivab) should be administered within 60 minutes of a temperature spike above 38°C (NICE, 2012). This Quality Improvement Project (QIP) sought to decrease the time from ‘temperature spike to needle time’ of ivab administration in a UK heamatology ward,

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 ward within 6 months.

Methods: Multiple interventions were identified, developed and implemented to decrease ‘temperature spike to needle time’ including: targeted teaching programme, pre-prepared ivab 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: In the baseline audit, two out of 14 (14.3%) neutropenic patients who spiked a temperature 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 or 3.6 hours. Temperature spike to administration of first dose ivab ranged from 40 minutes to 1987 minutes, with an average of 446 minutes or 7.43 hours.

Following the interventions, the audit at six months found, of the seven patients with neuropenic patients who experienced a temperature spike, four patients received ivabs within 60 minutes (57.1%). This represented a 42.8% reduction 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 as part of this QIP resulted in a 42.8% reduction in ‘temperature spike to needle time’ for first dose empiric antibiotics for heamatology patients on the inpatient ward. Challenges identified include the inconsistent availability of pre-prepared Future Use Prescriptions. Through the stakeholder analysis, this QIP has identified that further work is required to address the inconsistent use of pre-prepared Future Use Prescriptions and ongoing teaching is required. A key reflection during this QIP is the need to increase engagement and collaboration with key stakeholders to develop momentum, confidence and consistency towards embedding this practice change.

• Presentation Conference Type: Poster
• Conference Name: The UK Acute Oncology Society Conference
• Start Date: Sep 27, 2024
• End Date: Sep 27, 2024
• Acceptance Date: Aug 12, 2024
• Deposit Date: Jan 31, 2025
• Peer Reviewed: Not Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/13668602
• Additional Information: This was co-authored with a Student: Allison Ponsford (as first Author) and Julie Armoogum.