G200(P) A Quality Improvement Project to Help Improve the Management of Paediatric Patients Presenting to a District General Hospital with Fever and Possible Neutropenia

Children with cancer are at increased risk of infection. The disease itself and treatment used compromise the immune system. Children with fever and neutropenia may present to any Paediatric department, and show subtle signs and symptoms of infection. The focused and timely management of such patients is essential to prevent treatable infections progressing to sepsis and risking death. The availability of a supportive care protocol should aid the clinician, often faced with managing these high-risk patients out of hours. Aim To evaluate the management of Paediatric patients presenting to a district general hospital with fever and possible neutropenia over a 3-month period in accordance with the hospital’s supportive care protocol (current standard of care). Method The management of identified patients was retrospectively analysed against the supportive care protocol using a self-designed quantitative data collection tool. Paediatric trainees working in the same department were also asked to complete a questionnaire about their experiences with using the current protocol when managing patients with fever and neutropenia. Results 16 patients were identified as presenting with fever and possible neutropenia. 14 of these patients were managed according to the supportive care protocol. 2 patients with fever and confirmed neutropenia were not managed according to the protocol, and 2 patients with fever but not neutropenia were wrongly managed according to the protocol. Of those patients correctly managed according to the protocol deviations from the recommended standard of care were noted. Failure to complete a full set of observations and clinical examination, including examining the perineum, was found in 7 patients. The decision to continue or discontinue antibiotics following reassessment at 48 h was incorrectly made in 3 patients. Conclusions Paediatric patients with fever and neutropenia are not being managed according to the current standard of care. Paediatric trainees have identified that the development of a simplified proforma; printed and completed by the clinician at the time of assessment and throughout the inpatient stay will improve the management of patients with febrile neutropenia. Such a protocol has since been developed and following a series of departmental teaching sessions is now in use in this paediatric department.