SunderlandNeutropenic Sepsis Audit

Melanie Robertson – Nurse Consultant Oncology

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Neutropenic Sepsis

• January 2012 to December 2012• Total Number of Patients with suspected

Neutropenia – 137• Haematology 99• Oncology 38

• Total Number pts confirmed Neutropenia – 103

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Neut Sepsis pathways

• Number of Pathways completed – 47

• CHDU – 31• A+E -9• B28 – 7• AMU – 0

• Number of Pathways not completed – 90

• CHDU – 29• A+E – 35• B28 – 18• AMU – 8

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Antibiotics administered

Antibiotics time administered from admission• Within 1 hour – 71 (51%)• 1-2 Hrs – 25 (18%)• 2-3 Hrs – 6 (4%)• 3-4 Hrs – 3 (2%)• Documentation unclear or no time specified (for

admission or antibiotics) – 32 (23%)

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Traffic light tableJAN FEB

%MAR

%APR%

MAY%

JUN%

JUL%

AUG%

SEP%

OCT%

NOV%

DEC%

CHDU 60% 100%

66% 29% 50% 0% 100%

100%

25% 100%

45% 86%

B28 0% 0% 0% 0% 63% 50% 0%

A&E 100%

100%

0% 0% 40% 100%

100%

0% 80% 100%

83%

AMU 0% 0% 0% 100%

0% 50%

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Actions

• Updated neutropenic sepsis pathway• Encourage use of Neutropenic sepsis pathway• Integrate pathway to electronic health records• Increased training to recognise neutropenic sepsis

(medical induction training)• CQUIN target – RCA for patients not achieving 1

hour target.

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Meditech v6

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Auditing and Measuring outcomes

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Auditing and Measuring outcomes

• Analysis of emergency re-admission rates of patients with a diagnosis of cancer– 2009 Patient re-admissions 1283– 2011 Patient re-admissions 924

• Analysis of average LOS of emergency re-admissions of patients with a diagnosis of cancer– 2009 Average LOS 6 days– 2011 Average LOS 5 days

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Emergency readmissions

Totals 2009 - 2011 to date

2230

1417

0

500

1000

1500

2000

2500

Totals

2009-102011-12

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Emergency readmissions by tumour group

Emergency ReAdmissions 2009/ 10 & 2011/ 12

0

100

200

300

400

500

600

2009-102011-12

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Length of stay

AVG LOS from 2009 - 2011 to Date

8

76.5

7

7.5

8

8.5

Totals

2009-10

2011-12

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Length of stay by tumour group

Emergency ReAdmissions by Avg LOS

0246810121416

2009-102011-12

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Auditing and Measuring outcomes

• Re-admissions audit– Specifically patients admitted within 30 days of

planned chemotherapy• 68% of admissions not via Oncology• mean admission date following chemo administration was

9.8 days• Around 80% of patients were Breast/Lung/Colon• Around 70% were receiving palliative chemotherapy• Commonly admitted after Course 1 (C4)• Average LOS 6.5 days (2009) 5 days (2010)

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Next Steps

• Lung Acute Oncology Nurse• Introduce RAPA tool to identify more patients / patients at earlier

step e.g. A&E• Develop further ambulatory pathways

– Uncomplicated neutropenic sepsis– Hickman line infection

• AOS Nurse Practitioner education– Prescribing– ECG Interpretation– Radiology Interpretation

• Implementation of Advanced care planning (ACP) in Oncology• Radiology requesting

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AOS training

http://www.test.elearninglaboratory.co.uk/AO/story.html

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Thank You

melanie.robertson@chsft.nhs.uk

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