Sepsis is a major cause of morbidity and mortality in paediatric oncology patients, particularly during periods of neutropenia. The current international standard of care is recognised as rapid assessment and delivery of empiric antibiotics within one hour of onset of fever, for all febrile and potentially neutropenic patients^1,2 .

Although paediatric oncology services are centralised to tertiary hospitals in Australia, peripheral centres provide supportive care for this immunosuppressed group of patients close to home, in a “shared-care” model.

The objective of this study was to ensure delivery of empiric antibiotics to all children with fever and suspected neutropenia within one hour of presentation to tertiary and peripheral hospitals. We expected to observe this outcome within 12 months of implementation of an intervention and a sustained response after 5 years.

Methods     

The records of all oncology patients presenting to an emergency department over a 3 month period were reviewed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified through focus groups and a questionnaire involving patients, medical and nursing staff. These were evaluated to develop a management guideline. The introduction of this practice change was supported by staff education. Follow- up data was collected at 12 and 60 months post intervention.

Results

The median time to empiric antibiotics was reduced from 180 minutes to 75 minutes at 12 months post intervention and the results were sustained at 5 years, with the median time being 65 minutes.

Conclusions

The introduction of the guideline has resulted in an improvement in practice, meeting international guidelines with sustained results at 5 years after introduction at a tertiary and secondary hospital.