The Acute Oncology Service Where we are now Presentation by: Alison East Macmillan AO CNS Date: April 2013

One hour to antibiotic audit (11-3y-309) Time period – October April 2012 – 6 months Patients treated with neutropenic sepsis 16 cases reviewed and audited (Dr A Nicolle Cons Haematologist) Places where patients with Neutropenic sepsis were treated A&E MAU Chemotherapy Day Unit (CDU) Proportion that received antibiotics within one hour of arriving in hospital 37.5% n=6 4/4 received antibiotic on CDU within a PGD (100%) 2 received antibiotic in A&E Issues identified Improvement being seen promptly by a Dr in A+E CDU nurse led PGD and medical review occur in one hour A&E time delay from AB prescribed and administration by nurses 4/16 patients were prescribed tazocin TDS instead of the QDS Local action Results shared with emergency departments/relevant teams Visible red alert on patient PAS record Triage Tool generated when patient attends A&E Additional training arranged for A&E/MAU/Acute Response Team ART Immediate Triage tool assessment in emergency care areas Importance of 1hour A/B time emphasise Trust wide launch of NICE guidance Extend PGDs On going audit Use of DATIX risk management reporting

Breakdown of the data Diagnosis Number of Patients (n=16) Haematology patient - chemo 5 Haematology patient – no chemo 2 Lung cancer3 Breast cancer5 Rectal cancer1 Chemo day unit Medical Admissions A+E Less than 1 hour – 2 hours hours hours-32 Timing unavailable from notes --2

24 hour triage toolkit Chemo Day Unit Acute Response Team OOH 24 hour advice line LIVE May 2013 A & E part of admission assessment planned MAU Proforma developed to form part of the patient Electronic Medical Record All triaged calls followed up by AO CNS or Haem CNS

Existing Alerting System REACT Patient Administration System (Medway) PAS BI DB Medway Interface (Sender) Trust Integration Engine (Ensemble) Patient Watch list Medway Interface (Receiver) REACT Phase 1 (EXISTING) Alerting Engine Live PAS DB

REACT Phase II Escalation Engine Monitors unaccepted alerts and re- raises if they have not been accepted within a given period Rejected workflow * User must specify a reason or comment * The date, time, name of the user, and a mandatory comment are recorded and the alert is closed Accepted workflow * Upon acceptance the date, time and name of the logged in user are logged. * Data about the patient will be brought from the Dendrite and/or Medway system (C-diagnosis, date of last treatment, pro forma status) * Compliance check-box of steps to act as a work list *Completion step includes “ summary to:” action REACT User Interface (Secure web application) REACT Phase 2 (PROPOSED) Overview screen This screen will show all active alerts in one panel, and a list of the most recently closed alerts in another panel. Symbols/icons will be used next to each alert to progress towards completion of a work flow. Alert management * Shows an overview of all ‘open’ alerts * Allows ‘Accept’ or ‘Reject’ for new alerts DB

Optional Modules REACT Optional Extras Built-in Reports (inc Audit viewing) A number of formatted exportable and printable reports will be built in to the system and accessible from the front end. This would include summary data (i.e. compliance with 24 hour target) and audit viewing (who did what, and when?). Without this, reports would need to be generated by the informatics reporting team separately to the proposed solution. Active Directory Integration You can use the same login and password you use to log in to windows/ . This will allow the IT service desk to create new users for the system (by adding them to a group) Without this, usernames and passwords will be created by an administrator and each user would have a new login for this system.

ANY QUESTIONS