Background Our institution is the only tertiary paediatric oncology centre serving a low-income country with a population of over 35 million. Outcomes are limited by social factors, material resources and shortages of qualified health care workers. Many children do not benefit from available chemotherapy drugs due to high mortality from treatment-related toxicity.
Objectives To improve in-patient supportive care
Methods At the beginning of the intervention (July 2011) discussion among medical, nursing, and pharmacy staff identified sepsis as a top preventable cause of morbidity and mortality among paediatric in-patients. Monitoring of vital signs, safe systems for fluid and drug prescribing and administration, and a standardised approach to managing neutropaenic fever were identified as key areas for intervention. Several tools were designed and implemented to address these concerns, including a paediatric observation chart, modified Paediatric Early Warning Score, drug and fluid prescription charts, and local clinical guideline for management of febrile neutropaenia. Implementation of bedside charts and compliance with sepsis guideline were audited on ward round spot audits conducted on average twice per week over the course of three follow-up visits (April 2012 – July 2013).
Results Previous to these interventions no children had observations charted at the bedside and vitals were rarely documented in notes. Post implementation of bedside charts, over 90% of children seen on ward rounds had bedside observation, drug, and fluid charts. Vitals were recorded on average once per day, more often in children on the febrile neutropaenia protocol. Pulse, oxygen saturation and blood pressure were documented at least once per day in 75–95% of instances, and respiratory rate <20% of the time. Intravenous medications were charted as prescribed in >90% of instances where the drug in question was an antibiotic. Over 95% of neutropaenic children with a documented episode of fever in the preceding 12 h had appropriate antibiotics prescribed and administered as per local guideline.
Conclusion Our experience demonstrates that these simple interventions are sustainable and have improved the standard of patient care. This has been associated with earlier recognition and treatment of patients with febrile neutropaenia.