1. POP: Overcoming Barriers to Prompt Administration of IV Antibiotics to Oncology with Fever Patients
Title slide

2. Authors Diana Toney, BSN, RN Abby Manly, BSN, RN, CPEN
List under the poster title

3. Introduction
Best practice for oncology patients with fever is to receive IV antibiotics within 60 minutes of arrival to the Emergency Department (ED). The project purpose was to implement a pre-arrival process, coined “POP” to (1) decrease time to IV antibiotics for Oncology with Fever patients in the ED (2) measure patient/family satisfaction with the process.

4. n
Design and Setting
Design: Multi-site Quality Improvement Project Setting: Egleston and Scottish Rite Emergency Departments Model: This project used the Model for Improvement to achieve outcomes. Changes were tested using Plan-Do-Study-Act cycles. Goal: This project implemented a pre-arrival process that allowed ED staff to prepare for Oncology with fever patients prior to their arrival. The POP process sought to address the following, often-cited barriers to meeting Door To Drug (DTD) goals: lack of rooms, staff, and coordination of resources.
This is a quality assurance project that provided ED staff with a way to prepare for Oncology with fever patients.  This project used the Model for Improvement to achieve improvements. Changes were tested using Plan-Do-Study-Act cycles. 
This project addressed the following issues reported by front-line staff: lack of room availability for these patients, lack of staff available to quickly care of the patient, and lack of ability to coordinate the multiple resources needed to care for these pediatric patients in such a short period of time. 

5. Design and Setting (cont).
Intervention: A multidisciplinary team including the ED, Oncology Center, Transfer Center (arranges admission and acceptance of patients), Patient Access staff and Epic analysts designed the POP process.
Oncology Center: providers and patients/families were engaged and educated
Transfer Center: contributed to project design, obtained additional information from Oncology provider, and implemented technology to communicate the information to the ED
Patient Access staff: contributed to project design and modified typical workflows to accommodate POP patients
Epic Analysts: EMR analyst designed and implemented a new workflow to facilitate the POP process
This is a quality assurance project that provided ED staff with a way to prepare for Oncology with fever patients.  This project used the Model for Improvement to achieve improvements. Changes were tested using Plan-Do-Study-Act cycles. 
This project addressed the following issues reported by front-line staff: lack of room availability for these patients, lack of staff available to quickly care of the patient, and lack of ability to coordinate the multiple resources needed to care for these pediatric patients in such a short period of time. 

6. Design and Setting (cont).
Intervention: Steps of the POP process are as follows: 1. The Oncology Center educates patients and families to call their Oncologist once a fever develops. 2. If the oncologist confirms the patient needs to seek emergent care, he or she provides the Transfer Center with pertinent clinical information and a contact phone # for the patient. 3. The Transfer Center provides the ED charge nurse the contact phone # and places the patient on the electronic medical record board. 4. Patient Access lead contacts parent in order to register patient and generate account # for visit. 5. The ED Charge Nurse then speaks with the parent. This imperative step allows the ED staff to have an estimated time of arrival in order to adequately prepare for the management of the patient. Any central venous access limitation or difficulties are discussed and planned for. 6. While the patient is en route, ED staff prepare supplies, order medications, designate assigned caregivers, and prepare a room for the patient. 7. Upon arrival, the patient bypasses typical registration/triage and is immediately brought back to the prepared room. 8. Patient Access lead updates the account with accurate arrival time.
This is a quality assurance project that provided ED staff with a way to prepare for Oncology with fever patients.  This project used the Model for Improvement to achieve improvements. Changes were tested using Plan-Do-Study-Act cycles. 
This project addressed the following issues reported by front-line staff: lack of room availability for these patients, lack of staff available to quickly care of the patient, and lack of ability to coordinate the multiple resources needed to care for these pediatric patients in such a short period of time. 

7. Subjects
Population: Patients presenting to the ED with Oncologic conditions and fever. The following eligibility criteria were used to define the population:
Chief complaint of: “Fever in the Oncology/BMT/Aplastic Anemia,” “Immunocompromised,” or “Immunocompromised with fever”
Central venous access or chemotherapy in the past four weeks
Received IV antibiotics in the ED
Measures: DTD times were obtained by extracting ED Arrival and Medication administration times from the EMR to calculate the average DTD time per month per campus. Data was pulled for 12 months pre- and post-implementation.
Pre-Implementation Period: Feb Feb. 2015
Post-Implementation Period: Feb Feb. 2016
Patient satisfaction: Patients were surveyed using a visual 5-point fully-word-anchored unbalanced response scale.
Instruments: Patients received an anonymous printed survey that asked how satisfied the family was with the following:
Being called prior to arrival to the ED
The amount of time spent in the ED waiting room
The amount of time it took to begin caring for their child
The amount of time it took for a doctor to see their child
If doctors and nurses seemed to know about their child’s illness
The quality of care provided

8. Subjects
Measures (cont.): Patient satisfaction: Patients were surveyed using a visual 5-point fully-word-anchored unbalanced response scale.
Instrument: Patients received an anonymous printed survey that asked how satisfied the family was with the following:
Being called prior to arrival to the ED
The amount of time spent in the ED waiting room
The amount of time it took to begin caring for their child
The amount of time it took for a doctor to see their child
If doctors and nurses seemed to know about their child’s illness
The quality of care provided
Surveys were distributed and completed during the ED visit.

9. Results
DTD Times: Campus 1 and 2’s DTD times decreased 17% and 10%, respectively year over year. A two-sample t-test was performed on the DTD times, and the % change for both campuses was significant. The percentage of patients with DTD times ≤ 30 minutes improved on both campuses. A comparison of POP versus non-POP patients highlights the efficiency gained from the POP process. Patient Satisfaction: The percentage of patients and families who were ‘Very much’ satisfied with components of their child’s care was high.
What is in other category?

13. What is in other category?

14. Implications
This project facilitated the efficient delivery of evidence-based care and measured patient satisfaction. Time-to-antibiotic administration is a widely used quality measure for Emergency and Oncology departments, but many published reports indicate that DTD times of less than 60 minutes are challenging to achieve. This project provided a solution to barriers to meeting DTD goals. This project is easily replicable. It was shared with this institution from another via a quality conference forum. This process and its impact on patient outcomes would be easily transferrable to other departments, patient populations or institutions.

15. Acknowledgements
Children’s Healthcare of Atlanta (CHOA) ED Nursing Leadership, Providers and Staff CHOA AFLAC Nursing Leadership and Providers CHOA Transfer Center Nursing Leadership and Staff CHOA Patient Access Leadership and Staff CHOA Epic ASAP Analysts CHOA Nursing Research/Evidence Based Practice department Amy Pasmann MSN, BS, RN Nurse Director Primary Children's Hospital ED/RTU

16. Does Diana have CPEN?
Do we want to recognize Linda and Teresa, Added AFLAC staff.
Special thank you to Linda Riley, PhD, RN, Director of Nursing and Teresa Hammarback, ADD CREDENTIALS