Page 128 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F2.3 Staff Engagement and Empowerment 13:15 Room 421

A Cohort Study on Protocol-based Nurse-led Outpatient Management of Post-chemotherapy Low Risk Febrile
Neutropenia
2
1
1
Lim MY , Choy YP , Macy Tong , Cheng ACK 1
2
1 Department of Oncology, Princess Margaret Hospital, Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong
Introduction
Traditional management of post-chemotherapy febrile neutropenia requires hospital admission and intravenous administration
of broad spectrum antibiotics. Risk stratification approach is now adopted according to international guidelines in which
low risk patients can be treated less aggressively with oral antibiotics without compromising the outcomes. We therefore
developed a pilot programme consisting of patient education, empowerment on self-management and specialist nurses
input to put forward the management in outpatient setting, with the hope to reduce the cost to healthcare system and
psychological burden to patients related to hospitalisation.

Objectives
(1) To evaluate the efficacy and safety in managing low risk febrile neutropenia patients by a protocol-based outpatient
programme; and (2) to compare the outcome with standard inpatient care.

Methodology
Tuesday, 16 May This is a prospective, non-inferiority cohort study carried out in a single oncology centre. Patients with solid tumors, low risk
febrile neutropenia with Multinational Association of Supportive Care in Cancer (MASCC) score≥21 and good performance
status (ECOG 0-1) were included. Eligible patients were observed in day centre for four hours after first dose of oral antibiotics
and educated about self-monitoring of symptoms and daily body temperature before discharge. Telephone and clinic follow-
up were arranged by specialist nurses in following week to assess the progress. Primary outcomes included success rate of
outpatient treatment which defined as defervesce of fever without change in antibiotics, and hospital admission and major
adverse events related to febrile neutropenia. Mortalities and compliance to follow-up will also be evaluated.

Results
From September 2014 to December 2016, a total of 38 patients were enrolled. Almost all were female with breast cancers
(except one male patient with lung cancer). Majority of patients (94.7%, n=36) were managed successfully as outpatient. Only
two patients required subsequent hospital admissions due to persistent fever. Success rate was non-inferior to the historical
cohort managed as inpatient (95% confidence interval 0.827-0.985; non-inferiority margin of 0.825). No mortalities were
observed. Compliance to programme was satisfactory (100% to telephone and nurse clinic follow-up; 80.5% to daily body
temperature monitor).

Conclusions
Outpatient management of low risk febrile neutropenia is effective and safe through the implementation of a comprehensive
protocol-based programme with joint effort and engagement among medical staffs, oncology nurses and patients.

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