Hello pharmacists!

A nurse-initiated pilot protocol for high risk febrile neutropenia patients is going live today. This pilot protocol has been approved for patients with AML, ALL, MDS, and DLBCL admitted to oncology units ONLY (5MST/7MST). Oncologist and oncology APPs may order the protocol (ONC Adult Febrile Neutropenia PILOT) which allows the RN to initiate orders if the patient is neutropenic (ANC <1500) and experiences first fever (38.3℃ or 38℃ sustained for 1 hour). The nursing orders (NURSE Adult Febrile Neutropenia PILOT) include cefepime 2 g Q8H x2 doses ONLY, 2 sets of blood cultures, urinalysis, and a chest Xray if respiratory symptoms are present. The protocol will also order a Consult to Pharmacy to notify the oncology pharmacy team that the orderset has been initiated. The oncology pharmacist will work with the providers to determine if cefepime needs to be continued beyond the 2 doses included in the nursing orderset and also determine if additional antimicrobials are indicated. If the orderset is initiated outside the oncology pharmacists' hours, they will follow up in the AM. The SBAR attached provides more background and details related to the protocol and general febrile neutropenia management. I've also included some pertinent screenshots of the protocol order, nursing orders, consult to pharmacy, etc. 

Please let me know if you have any questions! I plan to present this in more detail at the next huddle.