5959 An audit evaluating the management of febrile neutropenia in paediatric oncology patients

Objectives The Pan London supportive care guidelines state that initial clinical assessment for patients with febrile neutropenia should include blood cultures and a full blood count as a gold-standard investigative process. Patients should immediately receive a senior review, and intravenous antibiotics (Abx) should be started within 1 hour following hospital admission.¹ According to the London paediatric acute care standards, patients should be seen by a middle grade paediatrician within 4 hours of an acute admission.² This audit has been carried out to investigate how stringently the guidelines have been adhered to in the management of febrile neutropenia. Methods Retrospective data collection and analysis of (n=50 patients) in a paediatric oncology unit was carried out between 2021 to 2023. Patients were categorised according to age at admission, sex, time and date of admission, neutrophil count on admission, time taken to administer Abx, type of Abx, highest level of professional who reviewed the patient, date, and time of senior review (recorded at registrar level), investigations received on admission, and the time of discharge (length of stay). Results The data shows only 1 patient in the sample received Abx within the recommended 1-hour limit, while 36% of patients received Abx over 5 hours after admission. However, this did not seem to have a significant impact on the length of hospital stay. 86% of patients were fully investigated as per regional guidelines, while 14% of patients did not receive a blood culture. Most patients received a senior review within 1 hour of admission with 87.8% receiving a senior review within 4 hours of admission to hospital. Conclusion Most patients received a prompt senior review with an FBC, CRP, kidney function tests and a blood culture as recommended. While patients are typically reviewed and investigated appropriately, there is a delay in the time taken to administer Abx. Although this did not seem to impact length of stay in hospital, frequent training courses can be introduced to increase awareness, so staff recognise the signs and act accordingly as it can be fatal. Limitations include a small sample size and restricted timeframe available to collect and analyse data. Future directions include a quality improvement project to explore this further. Follow-up studies should consider the time taken to administer Abx from the point when the episode started. The effects of not receiving Abx within the recommended 1 hour can also be investigated to establish the window of opportunity. References Great Ormond Street Hospital for Children NHS Foundation Trust, The Royal Marsden NHS Foundation Trust, University College London Hospitals NHS Foundation Trust. Paediatric Haematology & Oncology: Supportive Care Protocols. 2018. London Children and Young People's Strategic Clinical Network. London acute care standards for children and young people. 2016.