Resumen de Management of febrile neutropenia with filgrastim at the emergency department

Francisco José Rodríguez Lucena, Leticia Soriano Irigaray, Ana Cristina Murcia López, María Carmen Matoses Chirivella, María Morante Hernández, Inmaculada Jiménez Pulido, Andrés Navarro Ruiz

• 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