According to a retrospective study, the use of intravenous (IV) push antibiotics increased the timely administration of antibiotics prior to emergency department transfer and improved the efficiency of room use within an oncology urgent care clinic.

These results were first presented by Cara Fleming, NP, Memorial Sloan Kettering, New York, New York, at the 2024 JADPRO Live meeting in Grapevine, Texas.

At the Memorial Sloan Kettering Symptom Care Clinic, an oncology urgent care clinic to manage acute or urgent issues of oncology patients in an ambulatory setting, Cara Fleming, NP, and coauthors noted, “patients with infections or sepsis often did not receive antibiotics prior to transfer to the hospital.” The intravenous infusion time of 30 to 60 minutes leads to a longer room dwell time, and patients require specialized ambulance transfers which are not always readily available, leading to further delays. These longer in-room times affected room availability for other patients at the clinic.

An IV push policy guideline and electronic order sets were developed as part of a quality improvement project and implemented in April of 2022. A retrospective study was also conducted to compare the timely administration of antibiotics and room dwell time before this intervention was adopted and after.

Prior to the intervention (between April 2019 and March 2022), there were 6231 patients who required transfer to the emergency department. Of those patients, 26.3% received antibiotics before transfer, with an average room dwell time of 3 hours and 53 minutes. After the intervention (between April 2022 and December 2022), there were 1798 patients who needed transfer to the emergency department. Of those patients, 34.9% received antibiotics before transfer, with an average room dwell time of 3 hours.

These results show the introduction of IV push antibiotics in the outpatient setting can increase the timely administration of antibiotics and decrease room dwell time, allowing for more efficient utilization of rooms in the clinic.

Study authors highlighted an advanced practice provider’s ability to “take initiative and ownership in implementing quality improvement projects in their respective areas of expertise,” as well as “the safety of IV [push] antibiotics in terms of reaction rates as per prior literature.”

Future steps for this project include a plan to broaden the use of IV push at other appropriate locations within Memorial Sloan Kettering, further research into patient outcomes with IV push vs infusion antibiotic administration for sepsis, and partnerships with other oncological organizations to assess the need for IV push antibiotics in similar settings.

Source:

Fleming C, Majeed J, Cohen N, et al. Advanced practice provider led oncology urgent care clinics improve time to antibiotic administration through implementation of intravenous push policy in the prehospital setting. Presented at JADPRO Live; November 14-17, 2024. Grapevine, Texas.