TABLE 1. DoTT care bundle interventions and actions.

Category of intervention bundle – Fever in cancer	Actions
Step 1: Obtain vital signs	Temperature Blood pressure Heart rate Respiratory rate Capillary refill Oxygen saturation
Step 2: Swift patient evaluation and interventions	Airway and respiration If there is respiratory distress, provide oxygen If no improvement or deterioration, be ready for ventilatory support Circulatory and mental status Poor capillary refill, 20 mL/kg fluids in bolus,a repeat if patient tolerates up to 3 times If not improvement, consider vasopressors
Step 3: Systematic patient evaluation and antibiotic administration	Evaluation of patient from head to toe Medical history and systematic patient evaluation from head to toe, including perianal and perineal mucosal and skin folds areas Laboratory studies and imaging Blood cultures (from peripheral puncture and every lumen of indwelling catheter) Complete blood cell count Urine analysis and culture Imaging if indicated Antibiotic selection and administrationb Broad spectrum antibacterial, provide additional antimicrobial if risk for multidrug-resistant organisms
Step 4: Follow-up	Repeat evaluations of Step 3a daily until patient is stable Obtain additional studies based on findings and availability of resources Respiratory secretions (nasopharyngeal swabs, bronchoalveolar lavage) – viral, bacterial, fungal, and mycobacterial studies by cultures, PCR, antigen testing Chest X-ray imaging if respiratory symptoms or other indications Sinus evaluation if respiratory symptoms or other indications Diarrheic stools evaluation for gastrointestinal (GI) pathogens, including C. difficile toxins Abdominal imaging if GI symptoms Adjust antibiotic selection

Note:

^aPerform blood cultures at initial peripheral venous access, and/or from each of the lumen of existing catheters;

^bSelection of antibiotics based on Figure 1.

Source: Adapted from Caniza MA et al. (14).