Developing a national 'low risk' febrile neutropenia framework for use in children and young people's cancer care.

PURPOSE: A Delphi study was undertaken to develop a framework guidance that would rationalise and standardise the care of children with febrile neutropenia (FNP) across the UK. METHODS: A mailed Delphi survey was undertaken with health professionals working in children's cancer units. The survey employed two rounds of feedback on 22 practice statements drawn from a systematic review of clinical evidence. Consensus was assumed for any statement where 80+ % of respondents indicated that they "agreed" or "strongly agreed". RESULTS: Consensus was reached on 21 of the 22 practice statements in round 1 that were categorised into six areas: definition of fever and neutropenia, initial management and choice of antibiotic, defining low-risk patients, strategy in low-risk patients and alternative approaches. Consensus could not be reached on whether patients needed to be afebrile to be suitable for discharge and the required length of outpatient antibiotic treatment. CONCLUSIONS: A Delphi survey allowed the successful development of a national framework for identification and management of children with FNP. The use of an existing well-functioning professional network was key in this project's success.

Integrated care pathways: an audit tool in paediatric oncology.

The families of children undergoing treatment for cancer encounter many professionals with varying levels of training, experience and competency. This can lead to variance in the care and advice they receive. The aim of the audit described in this article was to improve care for children with fever and neutropenia by introducing an integrated care pathway. Guidelines for neutropenia were examined and a retrospective analysis of notes undertaken to study what was happening before a pathway was introduced. From this, standards were set and a pathway developed which was introduced to all members of the oncology unit and implemented as part of the children's care. This article will also focus on the audit and evaluation of the pathway. Following this, the pathway has been changed to reflect care and can now be used to introduce new evidence or research in this field.