Importance of Monitoring the Quality of Care of Patients with Febrile Neutropenia
| Název česky | Význam monitorace kvality péče o pacienty s febrilní neutropenií. |
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| Autoři | |
| Rok publikování | 2007 |
| Druh | Konferenční abstrakty |
| Fakulta / Pracoviště MU | |
| Citace | |
| Popis | Introduction: Febrile neutropenia (FN) is an iatrogenic life threatening complication of cancer treatment. The treatment strategy and the quality of care provided essentially influence on the treatment results of FN, particularly its morbidity and mortality. Therefore, a retrospective study was performed in our institution focussing on the complex evaluation of patients hospitalised for FN. Material and methods: 114 patients were evaluated who underwent the total of 126 admissions to hospital due to FN in 2004 and 2005. In order to make the care quality more objective, the Index of Care Quality (ICQ) was developed. The maximum of ICQ points was 20. The complexity of the objective finding and proper keeping of medical records were given 10 points; 2 points each: chest X-ray, regular monitoring of blood pressure, heart rate and temperature, balance of fluids, microbiological examination of biological material, patients education. The other parameters of the supportive care were monitored. Results: The sub-analysis of 66 cases so far closed has shown: Patients with breast cancer: 20%, gyneacological cancer: 20%, germinal cancer: 18% and gastrointestinal cancer: 15%. 50% of FN occurred after the 1st series of chemotherapy, 68% cases were neutropenia of grade 4, others grade 3. Females accounted for 69%, patients above 60 for 36%. Other frequent risk factors were mucositis: 55%, hypotension and/or tachyarrhytmia: 22%. The mean ICQ index was 16 points. In 80% cases the treatment was started by a combination of two antibiotics (53% ciproflox.+amoxicillin/clavul.). In 18% cases the initial therapy was changed. The antimycotics was applied in 44% patients (65% fluconazole). Treatment complications occurred in 40% cases (circulation instability, bronchopneumonia and metabolic disorganisation. 27% patients needed blood transfusion and 15% full parenteral nutrition. 9% patients died. The secondary prevention of FN was achieved by G-CSF (40%) or by the decrease of RDI of chemotherapy (33%). Conclusion: Although the results of the internal audit were acceptable, significant differences among individual departments were discovered. Therefore new nursing and therapeutic standards were developed, the FN care has been centralised and the electronic module "Reports on febrile neutropenia" has been introduced into the hospital information systm. Although these measures have been introduced recently, high effectiveness can be observed. |