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South West Nova District Health Authority
Policy & Procedure
TITLE:
Febrile Neutropenia in Cancer Patients
Effective Date:
January 2015
NUMBER: 800.750
Page (1 of 3)
Applies To: Nursing
POLICY
1. Chemotherapy induced febrile neutropenia is the most common complication related
to cancer therapy, and is a potentially life threatening medical emergency (CTAS 2).
Guidelines for the medical management of febrile neutropenia in cancer patients have
been developped by Cancer Care Nova Scotia to ensure cancer patients receiving
chemotherapy receive treatment based on best practice guidelines when they present
to emergency departments with cancer and fever.
2. The Oncology RN will provide verbal and written education to all cancer patients,
receiving chemotherapy in SWH, on what to do if they develop a fever of 38°C or
above or uncontrolled shivering. Patients and/or their caregiver must be aware of the
risk of fever and act promptly when a fever is detected.
3. All cancer patients receiving chemotherapy in Nova Scotia receive a “Fever in a
Cancer Patient” instruction and treatment recommendation yellow card (see Exhibit A)
and education providing direction on how to use the card in the event they develop a
fever. The patient should keep the card readily accessible.
4. The Oncology RN will instruct the cancer patient should they have a fever to come to
the Emergency Department, present the “Fever in a Cancer Patient” card upon arrival,
and let the emergency room physician know when he/she received the last
chemotherapy treatment.
5. The Emergency Department staff will triage and do a complete assessment of the
cancer patient presenting with fever based on the instructions on the “Fever in a
Cancer Patient” card
6. All medications and diagnostic tests on the “Fever in a Cancer Patient” instruction
card require a written physicians order.
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled
and should be checked against the server file version prior to use .
Page 2 of 3
Exhibit :A
Fever in a Cancer Patient
Solid Tumour, Hematology, Stem Cell Transplant
Instructions for Patients:


This card is ONLY to be used when you have a fever.
If your temperature is 38C (100.4 F) or higher:
 Do not take any medications to lower your fever, like acetaminophen or
ibuprofen.
 Go to your local Emergency Department right away and give this card to the
Emergency staff.
o This card alerts Emergency Department staff that you are a solid tumour,
hematology or stem cell transplant patient with a fever, and needing
treatment within 60 minutes.
o Although your care is a priority, you may still have to wait while other
patients, with more urgent concerns, are treated.
 During the next business day, call your cancer doctor/nurse and tell them you have
been seen in the Emergency Department.
_________________________________________________________________________
Instructions for Emergency Department Staff:






1
This patient has cancer and is febrile. Febrile Neutropenia1 is a medical emergency
(CTAS Level II). Patient is to be assessed and receive their first dose of antibiotics
within 60 minutes of presentation.
The patient does not need to be isolated
At Triage: CBC (to be drawn within 10 minutes and sent as STAT).
Blood Cultures: 2 sets (1 set = aerobic + anaerobic).
▪ If the patient has a central line: 1 peripheral set and 1 central set.
▪ If patient does not have a central line: 2 peripheral sets from different sites.
Obtain electrolytes, BUN, Cr, urinalysis and urine C&S, chest x-ray.
Other investigations as clinically indicated.
Febrile Neutropenia is defined as a single oral temperature ≥38.3C (101F) or
>38C (100.4F) for more than 1 hour, and an absolute neutrophil count <0.5 x10 9/L (500
cells/microlitre), or expected to fall below 0.5 x109/L (500 cells/microlitre).
Instructions for Emergency Department Staff: Management of Febrile Neutropenia
If the patient’s temperature is <38C when they present to Emergency Department, but they
have recorded temperatures at home >38C, they should still be considered febrile.
1. If patient is febrile and neutropenic, initiate broad spectrum antibiotics within 60 minutes,
Pipericillin-Tazobactam 3.375g IV q6h.
Or, if the patient has a penicillin allergy: Ciprofloxacin 400 mg IV q12h and
Vancomycin 1g IV q12h.
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled
and should be checked against the server file version prior to use .
Exhibit :A
Page 3 of 3
2. If the patient appears unwell (e.g: rigors, hypotension, etc), or lab results are delayed,
give the first dose of antibiotic(s) before the blood work results are back.
3.
High-risk febrile neutropenia patients require admission. After the physician has
completed the assessment and administered the first dose of antibiotics, admit the patient
to the appropriate service.
4. Low-risk febrile neutropenia patients may be treated as outpatients (refer to the CCNS
Oncologic Emergencies Guidelines to review low risk criteria and treatment guidelines).
5. The patient’s Medical Oncologist/Hematologist and treating cancer clinic should be advised
of the patients visit to the Emergency Department and their current status.
Produced by Cancer Care Nova Scotia, August, 2014
For more information, refer to the CCNS Oncologic Emergencies Guidelines
www.cancercare.ns.ca
REFERENCES
Cancer Care Nova Scotia (2014). Guidelines for the Management of Oncologic Emergencies
in Adult Patients-Full Version. ©Crown copyright, Province of Nova Scotia. Retrieved
at: http://www.cancercare.ns.ca/sitecc/media/cancercare/full%20version%20document%20revision%20july%2022.pdf
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled
and should be checked against the server file version prior to use .