Developing Acute Cancer Care at the RBFT Mark Foulkes Nurse - - PowerPoint PPT Presentation

Developing Acute Cancer Care at the RBFT

Mark Foulkes Nurse Consultant and Trust Lead Cancer Nurse Royal Berkshire NHS Foundation Trust

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16 February 2011 Members Event 2

Content

• Why is Acute cancer care important
• Neutropaenic sepsis (RBFT experience)
• Ongoing work
• Summary and questions

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Why is acute cancer care important?

• Nationally – lots of variation
• National reports show that it is often done badly…particularly

side-effects of chemotherapy

• Efficiency – cancer patients tend to spend long periods on
• hospital. Is this good for the patient (or the hospital!!)
• Government policy is to try and look after patients closer to their

homes but how do we support this when things don’t go to plan?

• Patients who present with new cancers via Emergency

Department…how are they best dealt with??

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Neutropaenic Sepsis – what is it?

• Dangerous side-effect of chemotherapy
• Infection on top of low white cell count
• Mortality around 9% for all patients who develop it
• White cells production hit by chemo…immune system

doesn’t work as well as it should

• People can look and feel quite well but deteriorate fast
• Recognise it quickly and treat with IV antibiotics (one hour)

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Audit 2009 - Clinical Detail – 1) Admitting Complaint

Neut Sepsis (40) Ascites (12) Chest/ SOB (20) Neuro signs (13) Cord Compress. (10) Pleural eff. (7) Terminal care (7) Naus and Vom (9) Collapse (9) Anaemia (7)

• ther (78)

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Neutropaenic Sepsis Admissions (40)

Breast (13) Lung (5) Lympho ma (4) Bowel (4)

• ther
• All on active chemotherapy
• Breast patients largest group (13)
• 11 of these patients on standard

chemotherapy

• Lung patients (5) all on oral

chemotherapy

• Three deaths within this group of

admissions (7.5%) all were receiving palliative chemotherapy for advanced cancer

• Average stay in hospital = 13 days

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Neutropaenic Sepsis Steering group

• Chaired by Assistant Director of Nursing (Anne Macdonald)
• Multidisciplinary – doctors from ED, CDU, microbiology,

haematology and oncology

• Nurses from Emergency Department, oncology, Trust senior

nurses

• Good protocol…’zero tolerance’
• Consultant champions driving change
• Care Bundles
• Good audit and reporting

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Care Bundles When do you use yours?

Antibiotic prescribing Central venous catheter Chest drain insertion Community Acquired Pneumonia Falls Neutropaenic sepsis Urinary catheter

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Audit 2010/11

• Audit on-going but…
• Similar numbers of patients admitted with NS
• Mortality rate 3.5% (one death) - in 2009 it

was 7.5% (three deaths)

• Length of Stay reduced by 50% (6.5 days) from 13 days

in 2009

• At start of audit period percentage of patients receiving

antibiotics was around 25%, now >90%

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HSJ Patient Safety Award 2010 - Winners

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But we need to do more….

• Working with ambulance service
• Near patient blood testing to reduce use of IV antibiotics

(although our current audit would suggest rate of resistant infection in population treated on protocol is not unusually high)

• Give drugs to prevent low white cell count (audit in

progress)

• Better sharing of information between departments

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Other acute cancer care work

• Develop direct admission process for ill cancer patients

using single point of access

• Develop direct admissions policy for ill cancer

patients…straight to a ward if we can

• More specialist cancer doctors to see patients when they

are admitted with problems relating to their illness

• Trying to stop people having to come here…and when

they do be very efficient

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That’s it…

−Any questions??