Beth Wittmer on Keeping Patients With Neutropenia Out of the Emergency Department

Informing patients about what to look for with neutropenia can help keep them out of the emergency department (ED) so they can be treated in the clinic, instead, said Beth Wittmer, RN, OCN, manager of care management at Florida Cancer Specialists and Research Institute.

Are there strategies to treat patients quickly in the office before they have to go to the emergency department if they have neutropenia?
And that’s our goal, is to try to keep them out of the ED. So, one, being proactive in calling the patient. If they finish the treatment, so this is from the care management perspective, the nurse is calling the patient to see how they’re doing, what kind of side effects they’re having—fever, of course, is the number 1 sign to watch for with neutropenia.

And as they’re white cells drop, their neutrophils drop. Neutrophils are your front line of fighting off an infection. So, if you don’t have the neutrophils there, the body’s response is different. It doesn’t say, “Hey, guys, we need your help from the macrophages and everybody else to come in and help surround the infection.”

Also, educating on foods that they should avoid: raw foods; raw vegetables, especially salad; berries, because they’re a little harder to wash, they can carry bacteria that normally our gut can handle, but someone who’s neutropenic can’t.

So, just making them aware of what to be cautious about. Check your temperature and report any symptoms that you’re having. And then, if we can, we take them in to see the physician, into our own clinics, if we can help that. Either bringing them in for potentially reviewing their [complete blood count] again, putting them on prophylactically on antibiotics. Sometimes those are done [intravenously] in the clinic, as well.
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