Development of a Care and Surveillance System for Febrile Neutropenia in Hematologic Cancer Patients Receiving Chemotherapy
Keywords:
System development, Care and surveillance, Hematologic malignancy, Chemotherapy, Febrile neutropeniaAbstract
Objective: To develop a care and surveillance system for febrile neutropenia in hematologic malignancy patients receiving chemotherapy.
Methods: This was a two-cycle research and development study aimed at developing a care and surveillance system for hematologic malignancy patients receiving chemotherapy. The sample consisted of hematologic malignancy patients receiving chemotherapy at the chemotherapy unit, monk patient ward, and medical ward at Sawanpracharak Hospital. Research instruments included a febrile neutropenia risk assessment form, Flow Fast Track Febrile Neutropenia protocol, and guidelines for care and surveillance of febrile neutropenia in hematologic malignancy patients receiving chemotherapy. Data were analyzed using descriptive statistics (frequency distribution, percentage, mean, and standard deviation), binary logistic regression, and paired t-test. The study consisted of two phases: Phase 1 (pre-development phase) included Step 1: problem assessment (R1) and Step 2: first system development (D1) using the nursing systems theory framework, comprising 1) planning, 2) implementation (R2), and 3) first evaluation. Phase 2 (second system development, D2) comprised 1) planning, 2) implementation (R3), and 3) system evaluation.
Results: The care and surveillance system for febrile neutropenia in hematologic malignancy patients receiving chemotherapy consisted of 7 components: 1) multidisciplinary team, 2) guidelines and standards, 3) resources and tools, 4) education and information provision, 5) monitoring and evaluation system, 6) facilities, and 7) communication and coordination, with 6 operational steps. Results from the two-phase system evaluation showed 6 cases of febrile neutropenia in the pre-experimental phase, 6 cases in Phase 1, and 4 cases in Phase 2. Compared to the pre-experimental phase, the incidence of febrile neutropenia decreased from 22.5% to 9.5%. The severity of febrile neutropenia decreased, and no high-risk cases were found in Phase 2.
Conclusion: This study found that implementing the care and surveillance system for febrile neutropenia in hematologic malignancy patients receiving chemotherapy reduced the incidence and severity of febrile neutropenia.
Keywords: System development, Care and surveillance, Hematologic malignancy, Chemotherapy, Febrile neutropenia
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วัจนา เนคมานุรักษ์, ลดาวัลย์ ฤทธิ์กล้า. การพัฒนาแนวปฏิบัติทางการพยาบาลในการป้องกันภาวะเม็ดเลือดขาวต่ำและมีไข้ (febrile neutropenia) ในผู้ป่วยที่ได้รับเคมีบำบัด. วารสารโรงพยาบาลธรรมศาสตร์เฉลิมพระเกียรติ. 2564;6(2):20-7.
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