Sunderland Neutropenic Sepsis Audit Melanie Robertson – Nurse Consultant Oncology
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SunderlandNeutropenic Sepsis Audit
Melanie Robertson – Nurse Consultant Oncology
Excellence in Health putting People first
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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