1 hour to antibiotics audit: Presentation Title Improving - - PowerPoint PPT Presentation

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1 hour to antibiotics audit: Presentation Title Improving - - PowerPoint PPT Presentation

Dec 13, 2022 326 likes •483 views

Acute Oncology Service 1 hour to antibiotics audit: Presentation Title Improving door-to-needle time for 36pt Arial Bold neutropenic sepsis. Sub heading 24pt Arial Changes to Neutropenic Sepsis Protocol. Dr Eirini Thanopoulou; AOS Lead Dr

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Presentation Title 36pt Arial Bold

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Acute Oncology Service

An Associated University Hospital of Brighton and Sussex Medical School

1 hour to antibiotics audit:

Improving door-to-needle time for neutropenic sepsis. Changes to Neutropenic Sepsis Protocol.

Dr Eirini Thanopoulou; AOS Lead Dr Emma O’Donovan; Haematology Consultant Lisa Jaccques; Lead AOS CNS

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Background

‘Acute Oncology Service’ concept

National Confidentiality Enquiry into Patient Outcome & Death (NCEPOD) 2008 35% hospitals care judged as good 49% hospitals room for improvement 8% hospitals less than good Recommendation: Systematic approach to dealing with cancer related emergencies 2009 – AOS service was conceived

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Acute Oncology Service core principles

  • Promote education
  • Increase awareness of oncological diagnoses
  • Early access to specialist oncology input
  • Integrated way of working amongst acute

specialties within NHS Trusts

  • Reduce fragmentation of care of unwell cancer

patients

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Key documents

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Audit Progress so far:

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Audit Period Mean door-to- needle time Median door-to- needle time % of patients getting antibiotics within 1 hour 2011 April-October 4 hours 35 mins 2 hours 49 mins 0% 2013 July-October 2 hours 3 mins I hour 34 mins 23% 2013-2014 November-April 1 hour 50 mins 1 hour 15 mins 10% 2014 July-December 1 hour 51 mins 1 hour 19 mins 26%

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Audit – Door-to-Needle Time

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Audit – Patients receiving antibiotics within 1 hour

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Education

  • AOS Nurse lead in ED appointed 2012
  • AOS Consultant lead appointed 2014
  • Giving regular teaching to ED, FY1,

FY2, SHO

  • 4th Haematology Consultant appointed

2013

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Next Step:

Updating the Neutropenic Sepsis Pathway

  • Switch to monotherapy
  • Easy to follow pathway
  • Education, Education, Education

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Key changes to guideline

  • 1. There was no formal written trust wide guideline
  • 2. Re-definition of neutropenia; neutrophils ≤0.5 (previously 1.0)
  • 3. Change to Piperacillin/Tazobactam monotherapy
  • Less toxicity (gentamycin) and less complications
  • 4. Easy to follow flow-sheet for 1st hour, first 24 hours
  • 5. Introduction of MASCC score and sepsis 6 scoring
  • 6. Flowcharts for 96 hours and 5 days with formulaic changes

to therapy suggested

  • 7. Antifungal and prophylaxis guidelines

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Future Plans

Neutropenic sepsis remains priority for AOS in 2015

  • Pilot new pathway in ED
  • Introducing Patient Group Direction (nurse led

treatment)

  • Process mapping in ED
  • Prospective audit of suspected neutropenic

sepsis

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Presentation Title 36pt Arial Bold

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Thank you!

Early detection and intervention frequently make the difference between living and dying in oncological emergency

An Associated University Hospital of Brighton and Sussex Medical School