Improving timely antibiotic administration in febrile neutropenia: A quality improvement initiative in a tertiary oncology hospital.

Abstract

e24152 Background: Febrile neutropenia (FN) defined as (100.4 degree F sustained for 1 hour ) with an absolute neutrophil count (ANC) <500/µL or <1000 /µL with anticipated decline to below 500 /µL in next 48 hours is an oncologic emergency, and early administration of broad-spectrum empiric antibiotics—ideally within 60 minutes of fever recognition—is recommended to reduce sepsis-related mortality. This study evaluated the effect of an audit-and-feedback plus teaching intervention on timely antibiotic administration and documentation in neutropenic fever. Methods: This quality improvement project employed a single Plan-Do-Study-Act (PDSA) cycle to improve timely antibiotic administration in febrile neutropenia from June 21 ,2025 to January 10, 2026. Plan: A standardized fever protocol was developed based on IDSA/ASCO guidelines. Planned interventions included: (1) development and dissemination of a standardized protocol and data-collection checklist; (2) training 100% of clinical staff by senior faculty member; (3) implementation of a fever alert system using chart flags for real-time notification (4) ensuring adequate antibiotic stock in ward pharmacy. Do: Protocol finalization with administrative approval (week 1), staff training by senior oncologist in oncology ward and emergency department (week 2), and full ward rollout with streamlined workflows ensuring timely nurse notification within 5 minutes, physician ordering within 15 minutes, and administration within 60 minutes. Study: Data was collected daily via checklist. Act: Barriers identified. Results: A clinical audit was conducted in the medical oncology ward. In cycle 1, all adult inpatients with established neutropenia who developed fever and met criteria for FN were included (N=26). Time from fever recognition to first empiric IV antibiotic was classified as “on time” (within 1 hour of fever onset) or “not on time”, and case-sheet documentation was reviewed for completeness. After analysis, findings were presented, and a focused bedside teaching session was delivered by a senior oncologist . A second audit cycle then included a new cohort of FN episodes (N=35), using identical definitions and outcomes. In cycle 1, antibiotics were administered on time in 11/26 patients (42.3%), delayed in 10/26 (38.5%), and documentation was inadequate in 5/26 (19.2%). Following the intervention, cycle 2 showed marked improvement: antibiotics were on time in 28/35 patients (80.0%), delayed in 5/35 (14.3%), and documentation errors decreased to 2/35 (5.7%). Conclusions: A simple, low-cost audit-and-feedback strategy combined with targeted teaching substantially improved process-of-care indicators for neutropenic fever . Integrating regular audits and structured education into routine practice may help align FN management with international standards in resource-constrained settings.