Following the (e-)Medication List From Pre-Admission to After Discharge at Norwegian Hospitals: An Actor-Network Analysis.

Pediatric AML requires multiple courses of intensive chemotherapy delivered over 7–10 days, followed by a recovery period when the effects of chemotherapy, such as severe neutropenia (absolute neutrophil count [ANC] <200/uL) and mucositis, manifest and then gradually resolve over 3–6 weeks. Many national and international guidelines, including those from the Children’s Oncology Group, strongly recommend that all patients receiving AML chemotherapy remain inpatient until resolution of severe neutropenia. This recommendation emerged in response to the CCG-2961 study’s unacceptably high treatment-related mortality (TRM) rate of 19%. The high TRM led to study suspension in October 1999 followed by an amendment mandating inpatient hospitalization for severe neutropenia periods. This change, coupled with additional recommendations for empiric management of febrile neutropenia and infectious prophylaxis, led to a decrease in TRM to 12%. These recommendations have remained in place for over 20 years. Removal of dexamethasone from AML chemotherapy and advancements in supportive care have led some centers in the United States to manage AML chemotherapy-associated neutropenia in the outpatient setting. Currently, 10%–25% of pediatric patients with AML nationally are discharged home to recover from neutropenia after completing chemotherapy. Previous work by our group showed patients discharged home with neutropenia but meeting strict clinical criteria (no fever, documented infection, or intensive care unit [ICU]–level care within 3 days of chemotherapy completion) had similar course-specific bacteremia rates and mortality to patients remaining in the hospital until neutrophil recovery. However, most patients monitored in the outpatient setting required readmission for fever or other complications after 7–9 days at home after discharge. This pediatric experience aligns with data from adult patients with AML cared for in the outpatient setting. Qualitative interviews of caregivers of pediatric patients with AML revealed that 85% of patients and caregivers were satisfied with their recovery location (ie, outpatient or inpatient).