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

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 Emma O’Donovan; Haematology Consultant Lisa Jaccques; Lead AOS CNS An Associated University Hospital of Brighton and Sussex Medical School

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 Slide 2

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 Slide 3

Slide 4 Key documents

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Audit Progress so far: Audit Period Mean door-to- Median door-to- % of patients needle time needle time getting antibiotics within 1 hour 2011 4 hours 35 mins 2 hours 49 mins 0% April-October 2013 2 hours 3 mins I hour 34 mins 23% July-October 2013-2014 1 hour 50 mins 1 hour 15 mins 10% November-April 2014 1 hour 51 mins 1 hour 19 mins 26% July-December Slide 6

Slide 7 Audit – Door-to-Needle Time

Audit – Patients receiving antibiotics within 1 hour Slide 8

Education • AOS Nurse lead in ED appointed 2012 • AOS Consultant lead appointed 2014 - Giving regular teaching to ED, FY1, FY2, SHO • 4 th Haematology Consultant appointed 2013 Slide 9

Next Step: Updating the Neutropenic Sepsis Pathway • Switch to monotherapy • Easy to follow pathway • Education, Education, Education Slide 10

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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 1 st 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 Slide 13

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 Slide 14

Early detection and intervention frequently Presentation Title make the difference between living and 36pt Arial Bold dying in oncological emergency Sub heading 24pt Arial Thank you! An Associated University Hospital of Brighton and Sussex Medical School