Risk stratification and febrile neutropenia
The Ottawa experience

Gail Macartney, RN, BScH, MScA, ACNP, CONC; Rosemary Zvonar, BScPhm, ACPR; Sheryl McDiarmid, RN, BScN, MEd, MBA, ACNP, AOCN; Barbara d’Entremont Harris, RN, BScN, IBCLC and Josee Laplante, RN, BScN, CONC

Despite many resources developed over the past several years, the care of the patient with febrile neutropenia remains largely based on subjective clinician choice. The scenario described in the case study opposite is very familiar to those who care for medical oncology patients. This paper outlines the evolution of a model of care developed for patients diagnosed with febrile neutropenia at The Ottawa Hospital, a multicampus 1000-bed teaching hospital.

 

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A complex care challenge
Febrile neutropenia is a common occurrence in cancer patients receiving chemotherapy. Clinical management of these patients is highly variable among different institutions and clinicians. Increasingly, selected patients considered to be at lower risk of life-threatening outcomes are being treated for febrile neutropenia as outpatients, which is beneficial to their quality of life and often offers overall cost savings. At The Ottawa Hospital, an interdisciplinary group has developed a series of patient assessment and management tools to guide the optimal management of cancer patients with febrile neutropenia, including standardized admission orders, an inpatient clinical pathway and outpatient care protocols.
 
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