Nurse-driven protocols for antibiotic initiation in febrile neutropenia

Mills RJ, Lusardi CG, Schad S, Mitchell MD, Landsburg DJ, Kucharczuk CR, Mull NK
Record ID 32018004896
Authors' objectives: Identify and summarize evidence on the effectiveness of nurse-driven protocols related to timely antibiotic administration in patients with febrile neutropenia.
Authors' results and conclusions: ▪ In recent years, research has been examining ways to decrease time-to-antibiotics (TTA) in febrile neutropenia due to the correlation of improved patient-centered outcomes when antibiotics are initiated in < 60 minutes. While there are evidence-based, internationally recognized guidelines that support expedited antibiotic initiation in suspected or confirmed febrile neutropenia, they do not make recommendations on how to achieve this goal. ▪ Due to the lack of guidance and a specific need to decrease TTA in febrile neutropenia, nurse-driven protocols including nurse-driven antibiotic initiation as opposed to usual care have been implemented. ▪ The evidence base for the effectiveness of nurse-driven antibiotic initiation in febrile neutropenia for TTA < 60 min was graded as low due to heterogeneity. Findings suggest that even with a more homogenous group, the results would be unlikely to change. The included studies are similar in that they all implement organizational change to direct patient care processes. Due to the heterogeneity of the studies, we are not able to determine which change is most effective, but instead, we are able to determine that general, organizational changes in nurse-driven antibiotic initiation prior to medical review can consistently improve TTA. ▪ There was only one previously published systematic review identified as relevant to this report. Due to the heterogeneity of the studies included, it was not able to state that one intervention is more effective than others and it did not include any quantitative data synthesis. ▪ Further, well-designed research and reporting is warranted due to the lack of relevant published guidelines, low quality of existing evidence, lack of evidence on adverse effects, and inconsistencies in findings of patient-centered outcomes.
Project Status: Completed
Year Published: 2023
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: United States
MeSH Terms
  • Febrile Neutropenia
  • Practice Guidelines as Topic
  • Anti-Bacterial Agents
  • Nurse's Role
  • Clinical Protocols
  • Time-to-Treatment
  • Sepsis
  • Fever
  • neutropenic
  • fever
  • sepsis
Organisation Name: Penn Medicine Center for Evidence-based Practice
Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104
Contact Name: Nikhil Mull
Contact Email:
Copyright: <p>Center for Evidence-based Practice (CEP)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.