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Door to Needle Neutropenic Sepsis Audit (Macmillan Chemotherapy Unit ) May 11– October 11

Door to Needle Neutropenic Sepsis Audit (Macmillan Chemotherapy Unit ) May 11– October 11. Baleseng Nkolobe NWLH NHS Trust Chemotherapy Lead Nurse/Matron. Auditors. Audit lead: Baleseng Nkolobe Other staff carrying out the audit: L. James Lead Consultant: Oncologist and Haematologist.

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Door to Needle Neutropenic Sepsis Audit (Macmillan Chemotherapy Unit ) May 11– October 11

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  1. Door to Needle Neutropenic Sepsis Audit(Macmillan Chemotherapy Unit )May 11– October 11 Baleseng Nkolobe NWLH NHS Trust Chemotherapy Lead Nurse/Matron

  2. Auditors • Audit lead: Baleseng Nkolobe • Other staff carrying out the audit: • L. James • Lead Consultant: Oncologist and Haematologist

  3. Scope of the Audit • Trust site specific: • Patients treated at NPH Macmillan Chemotherapy Unit • Following NCAG report • 6 monthly audit since January 2009 Speciality Adults only • Haematology • Solid tumour

  4. Background • The aim of this audit is to measure how long (time) patients receive antibiotics from the time they are assessed by medical/nursing team and diagnoses of neutropenic sepsis is made in an emergency unit in NWLH NHS Hospitals. • As stated in the measures for AOS Peer Review Measures “a patient should enter a pathway from the time the neutropenic sepsis diagnosis is made… admission to the pathway does not require confirmation by blood test” measure 11-3Y-308

  5. Standard Being Audited • Patient Safety – Diagnoses of neutropenic sepsis to 1st dose of IV antibiotics • Effectiveness of the action taken after the last audit (October 10-April 11)

  6. Aims • To measure time from diagnoses of neutropenic sepsis to first dose of intravenous antibiotics comparing it to Oct10-Apr 11 audit Actions from Oct 10- Apr 11 audit • No of patients decreased compared to September10 audit only 1 patient was admitted with diagnoses of neutropenis sepsis • The IAVB`s were administered in 7 hours (100% failure) • E-mail sent to A+E matron and CCSG informed of results

  7. Method • Retrospective audit using formulated criteria for collecting data • Data collected from information from medical notes and EPR timeline viewer

  8. Findings/Results • 11 patients episodes for 10 different patients compared to 1 episode in April 11 • (1 patient attended A+E 2 times) • 1 Patient from the 10 audited refused IVAB`s when offered within an hour, this patient was audited as he had neutropenic sepsis • 1 excluded as not neutropenic • Only 10 patient episodes audited

  9. Tumour site & Regimen

  10. GCSF & Central line

  11. Age Range No of patients

  12. Arrival Point No of patient episodes 10 patients

  13. Time To IVABS No of patients 40% 20% 20% 40% 100% 10% 10%

  14. Results/Findings IVABs given • 1 x Augmentin+ Clarithromycin • 1 x Clarithromycin + Co-amoxiclav • 2 x Meropenem • 1 x Piperacillin+ Tazobactam • 4 x Tazocin (+ 1 patient was also given G-CSF and 1 patient declined the IVABS) • 1 x Tazocin + Vancomycin (Paracetamol *2)

  15. Time To Admission 10 patients No of patients episodes

  16. Discussions & Recommendations • Number of solid tumour patients admitted in the last six months have increased from 1 to 10. • However, 40% of patients were treated within an hour of diagnoses/assessment in A+E. • The FEC-T regimen patients 2/4 had central venous access device (3/4patients were on first cycle of treatment) • The FOLFOX regimen is a regimen that requires patients to have a CVAD which is a contributing factor • The average length of stay for the 4 patients who were treated within an hour of diagnoses was 5 days, however; the longest admission was 13 days. This was a patient who also had a CVAD. • But for the 6 other patients who were treated after an hour of diagnoses an average stay in hospital of 7days. The longest hospital stay in this group was also 13 days. The patient who stayed the longest in hospital in this group declined the IVAB`s when they were offered within an hour of admission. • Recommendations: TO BE DISCUSSED AT CCS Group meeting • Patients starting chemotherapy to watch neutropenic sepsis DVD from the NWL Cancer Network to re-iterate the importance of treatment for neutropenic sepsis

  17. Feedback • Head of Service (Clinical Chemotherapy Services) • Clinical Chemotherapy Services Meeting • NWLH NHS Trust Audit • A+E Matron and Lead Consultant

  18. Actions Agreed and Dates

  19. References • National Chemotherapy Advisory Group (2009) Chemotherapy services in England: Ensuring quality and safety • National Confidential Enquiry into Patient Outcomes and Death (2008) • National Cancer Peer Review Programme: Manual for cancer services. Acute oncology-including metastatic spinal cord compression (2011) • http://www.macmillan.org.uk/

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