Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia

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In this article we learn about complications that occur in cancer patients who undergo chemotherapy such as febrile neutropenia and how the use of standardized order sets in the EHR can help this group of "patients ensure they receive prompt treatment for infection". [1] Febrile neutropenia is defined as an oncological emergency where the patient presents with fever accompanied by an absolute neutrophil level of under 500/mcl. The purpose is to avoid delays in the initiation of antibiotic treatment, delays in transferring patient to the inpatient unit, and delays in the administration of such medications. [1]


  • Retrospective chart reviewed was done and patients who had cancer and febrile neutropenia were selected.
  • Evidence based guidelines were researched and applied. They included appropriate use of antibiotics, laboratory tests and microbiology tests.
  • Development of standardized order sets that "use appropriate antibiotics" including adjustment guidelines based on the disease characteristics.
  • Interdisciplinary team was formed to plan, develop and implement the clinical guidelines with standardized order sets
  • The Independent-Samples T test for equality of means was used for statistical measurement.[1]


The findings were based on the antibiotic time interval. They found a significant decrease in the time the antibiotic was ordered and the time it was administrated. The length of stay in the hospital of most patients was reduced. However, there was also several confounding factors that influence the results. These were patients who were newly diagnosed and required longer stay as well as those who developed complications.


The use of Evidence-based medicine is important in providing essential tools that will help the clinician provide better health care outcomes in patients[1]. The implementation of EBM will cause a change process for those who will adopt and adapt to this effective method that is aimed at reducing delayed diagnosis and delayed treatment that can eventually lead to medical errors.

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  1. 1.0 1.1 1.2 1.3 Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia,,Best, J. T., Frith, K., Anderson, F., Rapp, C. G., Rioux, L., & Ciccarello, C. (2011, November). In Oncology nursing forum (Vol. 38, No. 6, pp. 661-668)Chicago