Development and Evaluation of a Management Protocol for Febrile Neutropenia in Solid Tumor Patients Receiving Chemotherapy at a Provincial Hospital

Abstract

Objective: To develop a guideline for the management of febrile neutropenia (FN) in solid tumor patients receiving chemotherapy. Methods: The study applied the Plan-Do-Check-Act (PDCA) concept of quality improvement in conjunction with focused discussion groups among relevant multidisciplinary. The study consisted of 4 phases. Phase 1 planning and system design involved the examination of the situation of FN in solid tumor patients receiving chemotherapy. Data collection from electronic databases led to group discussions to develop guidelines for managing FN. Phase 2 System Implementation was the use of developed guidelines and its improvement. Phase 3 Evaluation compared the incidence of FN at three months before and after guideline implementation. Phase IV involved recommendations for further improvement. Results: Patients with neutropenia received different preventive measures and monitoring because there were no clear guidelines within the organization. Therefore, the relevant multidisciplinary teams had jointly formulated the guideline consisting of: 1) risk assessment by examining absolute neutrophil count (ANC) 2) prevention: Use of granulocyte colony stimulating factor (G- CSF) should be considered in patients at risk and 3) surveillance: high-risk patients should be monitored in the hospital and should be given G-CSF. After adopting the guideline, the incidence of FN decreased from 3.2% to 0.9% (P=0.34). Some patients at-risk were not given prophylactic G-CSF. The finding led to recommendations to improve procedures and increase risk assessment criteria to be more comprehensive. Conclusion: The application of the PDCA quality improvement concept in the analysis and problem-solving results in an effective guideline that is accepted by practitioners for risk assessment and G-CSF administration for prevention and surveillance.