Oncology Patient Presenting with Fever Clinical Pathway
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Treatment for Special Patient Populations

Triage/Contact Precautions (ED)
Consider need for Sepsis Huddle

RN/MD/CRNP Rapid Assessment

RNLine access, CBC, Blood Culture
MD/CRNPOrder Antibiotics, CBC, Blood Culture
Consider need for stress dose steroids, excluding CART-19 patients

Complete History, Physical Examination
Further Diagnostic Testing

 

 
 
Ill patient
Broviac or PICC
Port
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Ceftriaxone
No Line
  • 1. Cefepime
  • 2. Vancomycin
  • 3. Gentamicin
ED Sepsis Pathway
as clinically indicated
Oncology Consult
(ED patients)
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Admit
  • 1. Cefepime
  • 2. Gentamicin
  • 3. +/- Vancomycin
Oncology Consult
(ED patients)
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Admit
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No Neutropenia
No Neutropenia
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Oncology Consult
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Ceftriaxone
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Oncology Consult
No antibiotics
Discharge
Assess Risk
Discharge
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LOW RISK
NOT LOW RISK

To be considered for discharge, the patient must:

  • Have no defined bacterial illness
  • Have no visible disruption of mucocutaneous barriers, AND
  • The expected period of neutropenia is ≤ 7 days

The patient must also meet all other low-risk criteria:

Low-risk Criteria: Clinical

  • Age > 6 months
  • Tolerating PO, able to take enteral medications
  • HPE consistent with likely viral illness
  • Reassuring physical exam, VS
  • Low concern for focal, invasive bacterial or fungal conditions such as:
    • Pneumonia
    • Cellulitis
    • Urinary tract infection

Low-risk Criteria: Medical History

  • No history of:
  • Trisomy 21
  • BMT within preceding 12 months
  • Currently therapy for GVHD
  • Received > 15 days of glucocorticoids in last 30 days
  • Current use of broad-spectrum antibiotics
  • Any surgery in the preceding 2 weeks, excluding line placement
  • VP shunt, Ommaya reservoir, or other implanted devices at present, excluding ports
  • Current CART-19 therapy patients (history of engineered cell therapy infusion)

Low-risk Criteria: Social

  • Family able to:
  • Follow up in clinic in 24-72 hours
  • Receive daily follow-up calls
  • To fill Levofloxin prescription
Posted : February 2008
Revised : November 2011, December 2012, January 2014, March 2014, December 2014, March 2015
Authors : B. Ku, MD; A. Reilly, MD; C. Jacobstein, MD; J. Lavelle, MD; L. Kersun, MD