Quality Improvement Project Improves Timeliness of Antibiotic Administration in BMT Patients

Sabrina Banegas, RN, BMT-CN

There is always room to improve the timely administration of antibiotics following the first signs of fever in patients receiving blood marrow and transplant (BMT), according to Sabrina Banegas, RN, BMT-CN. One way is through education efforts and the creation of double-lumen central venous catheter (CVC), triple-lumen CVC, and port access blood cultures kits.

Data presented by Banegas at the 48th Annual Oncology Nursing Society Congress from a multidisciplinary quality improvement project demonstrated that there was a 6% improvement following implementation of the intervention from 10% compliance to 16%. The average time from first fever to antibiotic administration was 1 hour and 36 minutes with fever defined as a patient temperature of 38.3 °C or 38.0 °C for more than 1 hour.

“Making sure nurses are prioritizing that antibiotic administration and not getting hung up on the other things that could wait [is important],” Banegas said. “Giving that antibiotic within a timely manner is going to make the biggest difference [in patient outcomes].”

In an interview with Oncology Nursing News®, Banegas, the team lead on 4East-Hematology/Oncology/Blood and Marrow Transplant/IEC unit at Mayo Clinic Arizona, discussed challenges that remain with timely administration of antibiotics following fever.

Oncology Nursing News: What was the rationale for investigating antibiotic administration times?

Banegas: One of the adverse events from BMT in patients receiving chemotherapy is neutropenia. [In our clinic], one of our patients was declining and they were transferred to the intensive care unit, so we did a chart review, and it was identified that there was a delay in their antibiotic administration. That led to an extensive chart review of our patient population; [we were] looking at the timing of administration of those antibiotics and for first fever onset.

What was the intervention and how was it evaluated?

One of the interventions for this project was we created was blood culture kits for our central line. Most of our BMT patients either have a PICC line, so a double-lumen, a triple-lumen, a central line, or a port, [and] these kits contain essentially every item that you need to draw blood cultures. This helped save time for the bedside RN [because] instead of having to grab all the supplies they needed to draw those blood cultures, it was all together in a kit.

That was one of the interventions that we implemented [and] the other was education. We created a visual aid that was a first fever workflow. Essentially, [it was] a step-by-step visual aid of what do you do when your patient has a first fever. It’s a visual guide that we posted on all the nurse’s stations so it’s easy for that nurse to quickly look at a good reminder for what they need to do. We put all this information in our weekly newsletters as well and did walking rounds for further education.

After looking at the intervention did anything surprise you?

The preintervention data showed that our unit specifically was administering antibiotics within that 1-hour timeframe of that first fever onset only 10% of the time. That was shocking to find that we were that low in compliance.

The postintervention data showed that our unit was administering the antibiotics within that 1-hour of fever onset 16% of the time. So, we made a little increase. It’s still not where we would like it [to be] and it was surprising [because] we expected to have greater compliance with that. That shows that there’s always room for improvement and hopefully we’ll continue this project as well.

Moving forward how do you hope to continue to increase that compliance?

In terms of increasing that compliance, one of the challenges is we’re onboarding new staff frequently and making sure that staff has that knowledge base on what our practices are. One of the biggest challenges [is] making sure that our education is consistent. We also onboard a lot of new graduate nurses who are not as familiar with these processes. It is going to go back to that education and reiteration with staff on not just our process, but also the importance and major role that we have in helping to prevent sepsis by administering those antibiotics within a timely manner.

Another challenge would be the process of coordinating care for your patient who has that first fever. There are a lot of steps that go into that from contacting the provider, administering the Tylenol, and then drawing those blood cultures.

What is the big takeaway from this project that you would want to share with colleagues?

The biggest takeaway is that there’s always room for improvement; I was expecting that our unit would have greater than 10% compliance.

Specifically, BMT patients [have] fevers a lot, and we play such a big role in helping to prevent sepsis by administering that antibiotic within a timely manner. It seems like such a simple intervention, but if we can administer it as soon as possible when that fever onset [occurs], we can make such a big difference in patient outcomes.

Reference

Banegas S. Timing of antibiotic administration after first fever in blood and marrow transplant patients. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed May 26, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12438