Developing Acute Cancer Care at the RBFT Mark Foulkes Nurse Consultant and Trust Lead Cancer Nurse Royal Berkshire NHS Foundation Trust
Presentation title here Content • Why is Acute cancer care important • Neutropaenic sepsis (RBFT experience) • Ongoing work • Summary and questions Members Event 16 February 2011 2
Presentation title here 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?? Members Event 16 February 2011 3
Presentation title here 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) Members Event 16 February 2011 4
Presentation title here 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) other (78) Members Event 16 February 2011 5
Presentation title here Neutropaenic Sepsis Admissions (40) • All on active chemotherapy Breast • Breast patients largest group (13) (13) • 11 of these patients on standard Lung (5) chemotherapy • Lung patients (5) all on oral Lympho chemotherapy ma (4) Bowel (4) • Three deaths within this group of admissions (7.5%) all were other receiving palliative chemotherapy for advanced cancer • Average stay in hospital = 13 days Members Event 16 February 2011 6
Presentation title here 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 Members Event 16 February 2011 7
Care Bundles Presentation title here When do you use yours? Antibiotic prescribing Central venous catheter Chest drain insertion Community Acquired Pneumonia Falls Neutropaenic sepsis Urinary catheter Members Event 16 February 2011 8
Presentation title here Members Event 16 February 2011 9
Presentation title here 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% Members Event 16 February 2011 10
Presentation title here HSJ Patient Safety Award 2010 - Winners Members Event 16 February 2011 11
Presentation title here 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 Members Event 16 February 2011 12
Presentation title here 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 Members Event 16 February 2011 13
Presentation title here That’s it… − Any questions?? Members Event 16 February 2011 14
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