Cedar Ward wiki Second brain · teaching copy · not KHCC policy

Five notes from five files

Each policy became one short wiki note: the rules, the links, the open questions. The quality briefing is summary.html. Markdown sources live in wiki/.

Febrile neutropenia

febrile-neutropenia.md · POL-CW-01 v3.1 · Infectious Diseases · 0–18 years

Rules

Fever = 38.3°C once, or 38.0°C for one hour.
Neutropenia = ANC below 500. Come to ER the same evening. No paracetamol first.
Door-to-antibiotic 60 minutes. Peripheral culture first. Pip-tazo (cefepime if rash). Not ceftriaxone.
Two named caregivers only while neutropenic.

Open questions

Review due March 2026. The discharge leaflet was required to match this file and does not.

Central venous access devices

central-line.md · POL-CW-02 v2.0 · Vascular Access · under 16 years

Rules

Neutropenia for line decisions = ANC below 1000.
Saline flush. No heparin on PICC/Broviac — except the same file sends every line home with a heparin lock.
Skin prep: chlorhexidine 4% aqueous, no alcohol.
Fever: notify attending within 2 hours. Line culture first. Vancomycin + cefepime.

Open questions

Ages 16–18 have no line protocol in this folder. 4% aqueous CHG may be the wrong product.

Visitor rules and protective isolation

visitor-isolation.md · POL-CW-03 v1.8 · IPC · review overdue

Rules

Visiting 10:00–20:00. Well adult visitors, no cap. No visitors under 12.
Protective isolation if ANC below 500. Spill kit in dirty utility cupboard B.
Influenza visitors: stay away until 3 days after the fever starts.

Open questions

Unlimited adults vs two named caregivers in POL-CW-01. Influenza window looks short.

Hazardous drugs (chemotherapy) safety

chemo-safety.md · POL-CW-04 v4.0 · Pharmacy + Nursing · 0–21 years

Rules

Closed system. Hold a cycle if ANC is 1000 or lower unless the protocol says otherwise.
Night fever after an infusion: day unit in the morning if the child looks well.
Doxorubicin extravasation: warm compress (flagged as an error).
Spill kit: Room 12 clean utility — not the dirty utility.

Discharge and after-hours fever advice

discharge-fever.md · POL-CW-05 v1.4 · Nursing Education · ID has not signed

Rules families are told

ANC = “white cells plus the bands” (flagged as an error).
38.0°C and well: paracetamol, clinic next working day. Fever alone can wait.
In ER: antibiotic within 90 minutes; usual drug ceftriaxone.
Every line goes home with a heparin lock.

Open questions

This is the highest-risk file: it is what parents take home, and it undoes POL-CW-01.