________ Physicians What percentage of patients at your institution who died of refractory cancer in 2018 had consultations from your palliative care program 30 days or more prior to death? ________% VALIDATE: 0 B30 100. ELSE DISPLAY: Please enter a numeric value between 0 and ≤ ≤ “B30: 100.” Does your institution track the time to antibiotic delivery (from time of initial triage in the emergency department, ambulatory clinic, or direct admission to inpatient hospital floor until first dose of antibiotics administered) for pediatric cancer patients presenting with febrile neutropenia (see code list)? Yes Go to Question B31.1 – No Skip to Question B32 – B31.1 If yes, what percentage of these patients received intravenous treatment antibiotics within 1 hour of initial triage (period from time of initial triage to time that antibiotics were administered) in the emergency department / ambulatory clinic / inpatient hospital floor during the last 3 months of 2018? [Calculate the percentage as the number of these patients receiving intravenous treatment antibiotics within 1 hour of initial triage divided by the total number presenting with febrile neutropenia during that time.] ________% WARNING: If B31=YES and B31.1=BLANK, DISPLAY: Please provide “B31.1: a value or answer No to B31.” VALIDATE: 0 B31 100. ELSE DISPLAY: Please enter a numeric value ≤ ≤ “B31: between 0 and 100.” Did your hospital track seasonal influenza vaccination for patients with the following codes (see code list) on active chemotherapy in your Pediatric Cancer program between October 1, 2018 and December 31, 2018? Yes Go to Question B33 – No Skip to Question B34 – Of the total vaccine eligible active chemotherapy patients (see code list) in your Pediatric Cancer program seen between October 1, 2018 and December 31, 2018, what percentage received seasonal influenza vaccine (at your hospital or elsewhere) during that time period or earlier that season? ________%
________ Physicians What percentage of patients at your institution who died of refractory cancer in 2018 had consultations from your palliative care program 30 days or more prior to death? ________% VALIDATE: 0 ≤ B30 ≤ 100. ELSE DISPLAY: “B30: Please enter a numeric value between 0 and 100.” Does your institution track the time to antibiotic delivery (from time of initial triage in the emergency department, ambulatory clinic, or direct admission to inpatient hospital floor until first dose of antibiotics administered) for pediatric cancer patients presenting with febrile neutropenia (see code list)? Yes – Go to Question B31.1 No – Skip to Question B32 B31.1 If yes, what percentage of these patients received intravenous treatment antibiotics within 1 hour of initial triage (period from time of initial triage to time that antibiotics were administered) in the emergency department / ambulatory clinic / inpatient hospital floor during the last 3 months of 2018? [Calculate the percentage as the number of these patients receiving intravenous treatment antibiotics within 1 hour of initial triage divided by the total number presenting with febrile neutropenia during that time.] ________% WARNING: If B31=YES and B31.1=BLANK, DISPLAY: “B31.1: Please provide a value or answer No to B31.” VALIDATE: 0 ≤ B31 ≤ 100. ELSE DISPLAY: “B31: Please enter a numeric value between 0 and 100.” Did your hospital track seasonal influenza vaccination for patients with the following codes (see code list) on active chemotherapy in your Pediatric Cancer program between October 1, 2018 and December 31, 2018? Yes – Go to Question B33 No – Skip to Question B34 Of the total vaccine eligible active chemotherapy patients (see code list) in your Pediatric Cancer program seen between October 1, 2018 and December 31, 2018, what percentage received seasonal influenza vaccine (at your hospital or elsewhere) during that time period or earlier that season? ________%
B_Cancer_2019.docx