Clinical practice guideline- and care pathway-inconsistent care following implementation of adapted infection management care pathways.

PURPOSE: Impact of infection management care pathway implementation is uncertain in pediatric cancer. Objective was to determine whether fewer patients received clinical practice guideline (CPG)- and care pathway-inconsistent care after implementation of an adapted infection management care pathway compared to pre-implementation.

METHODS

We implemented adapted infection management care pathways based on CPGs for prophylaxis, and initial, ongoing, and prolonged fever and neutropenia (FN) management in three centers. We conducted a retrospective chart review, sampling patients with episodes of high- and low-risk FN, pre- and post-implementation of the care pathway. Up to five chemotherapy cycles per patient were adjudicated for antibacterial and antifungal prophylaxis care pathway inconsistency. Among these cycles, FN episodes were identified, and one was randomly chosen per patient. CPG- and care pathway-inconsistent actions were adjudicated.

RESULTS

Three hundred seventy-five patients were assessed for eligibility, and 272 were included. For prophylaxis, 115 pre-implementation and 57 post-implementation high-risk cycles were evaluated. For FN, 82 pre-implementation and 42 post-implementation episodes were evaluated. Antifungal prophylaxis inconsistency decreased in the post-implementation period compared with the pre-implementation period (P = 0.023). However, there were no other significant differences in CPG- or care pathway-inconsistent actions by period. In both periods, CPG- and care pathway-inconsistent actions were common.

CONCLUSIONS

Implementation of adapted care pathways for infection management was associated with fewer patients receiving care pathway-inconsistent antifungal prophylaxis. However, it did not reduce other CPG- or care pathway-inconsistent actions. Inconsistent actions for FN management were common in both periods. Targeted approaches are required to improve care pathway-consistent infection management in pediatric cancer patients.