Management of febrile neutropenia with filgrastim at the emergency department

• Autores: Francisco José Rodríguez Lucena, Leticia Soriano Irigaray, Ana Cristina Murcia López, María Carmen Matoses Chirivella, María Morante Hernández, Inmaculada Jiménez Pulido, Andrés Navarro Ruiz
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 19, Nº. 4, 2017, págs. 262-269
• Idioma: inglés
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• Resumen

  • Febrile neutropenia (FN) is defined as a serious complication with a mortality rate of seven tol 1% in hospital patients. More than 50% of patients with fever and neutropenia have some type of infection. Immunomodulatory agents such as colony stimulating factors (CSF) have been showed to be beneficial in high-risk patients. Although they are probably overused in clinical setting, they reduce duration of neutropenia and accelerate patient recovery. Objective: To describe the use of filgrastim, which is an immunomodulatory agent like CSF employed in the emergency department (ED) of our hospital in Spain; to develop possible pharmaceutical intervention measures with the aim of improving the rational use of CSF to assess the effectiveness and continuity of the improvement process. Method: Study of filgrastim prescriptions in the ED during two periods. First period of this study was a prospective observational study of filgrastim prescriptions without any intervention by Pharmaceutical Department. After experts' evaluation, second period of study endeavored to establish CSF prescription-checklist as an essential requirement. Usefulness of continuity of healthcare quality improvement process was thus assessed. Results: One hundred patients were recorded during two study periods (51:49). In first period, according to the algorithm, 27% of the patients complied with ASCO practice guideline. Meanwhile entering checklist, 61% was observed (p <0.01∗). Statistical significance was also observed in the absolute neutrophils count (441.5/mm3 versus 280.5/mm3). Conclusions: Introduction of filgrastim prescription-checklist for patients with onco-hematological cancer improved compliance and recommendations for CSF use in management of FN in an ED