Abstract
Purpose: Implement interventions to promote sustained success for a PI project initiated in 2015 in a pediatric ED to improve antibiotic administration times for patients with therapy-induced neutropenia and fever.|Background: In June 2015, a PI project with aims to reduce the time to antibiotics (TTA) for patients presenting to the emergency department with therapy-induced neutropenia and fever. Previously, 0% of patients received antibiotics within 60 minutes. Post-implementation, 83% of patients received antibiotics within the recommended time. However, since initiation of this original PI project, and despite any significant systems changes, there have been periods of decline in goal achievement.|Sample/Setting: The study will take place at a Level II pediatric trauma ED. The unit currently sees an average of 34,000 visits annually and an average of 6.2 chemotherapy induced neutropenia and fever patients monthly. This study analyzed TTA for patients who presented to the pediatric ED with a fever of 38.0C or higher and currently receiving chemotherapy for oncologic disease. Only bedside nursing staff who provide ED care for these inclusion patients will be included in survey data collection and targeted education.|Methods: This used a PI model of Plan, Do, Check, Act to implement interventions aimed to improve the sustainability of a previously initiated PI project. Interventions aimed at improving sustainability with the focus on staff motivation. This study used retrospective data collection, pre-intervention staff surveys, and a series of 3 interventions to promote staff motivation, leadership, and ownership of the evidence-based behavior changes.|Results: 53% of nurses responded to the pre-intervention survey. Of those, 81.25% thought that a 60-minute TTA was realistic. 18.75% thought it was "somewhat realistic." 75% of participating nurses saw no significant barriers to achieving TTA. Post-implementation, data showed an average TTA of 53, 48, and 47-minutes, with 19 of 24 patients receiving antibiotics within goal time. Of the 4 patients that did not receive antibiotics on time, 3 of the 5 delayed patients had MD/PA/NPs placing orders rather than the Triage RN.|Conclusion: Early data after the implementation of the interventions is inconclusive at this stage of the research process. Continued monitoring of TTA will be needed to determine if long-term sustainability has improved.