Newcastle upon Tyne Hospitals NHS Foundation Trust Audit results for NAOG meeting 19 April 2013 The Newcastle upon Tyne Hospitals NHS Foundation Trust

Acute Oncology in Newcastle Hospitals RVI –A&E, medical admissions unit –neurosurgery –no chemotherapy/radiotherapy  referrals are mainly new diagnosis of cancer, complications of cancer  very few cancer treatment toxicities Freeman –cancer centre (NCCC), oncology, haematology, BMT, chemo, radiotherapy –no acute medical admissions  almost all cancer treatment toxicities come direct to NCCC  many complications of cancer come direct to NCCC  very few with new diagnosis of cancer

Acute Oncology in Newcastle Hospitals RVI –A&E, medical admissions unit –neurosurgery –no chemotherapy/radiotherapy  referrals are mainly new diagnosis of cancer, complications of cancer  very few cancer treatment toxicities Freeman –cancer centre (NCCC), oncology, haematology, BMT, chemo, radiotherapy –no acute medical admissions  almost all cancer treatment toxicities come direct to NCCC  many complications of cancer come direct to NCCC  very few with new diagnosis of cancer AOS NCCC on-call team

One hour to antibiotics audit Trustwide audit of all admissions with suspected neutropenic sepsis 1 Jan 2012 to 30 Jun 2012 identified by AOS (RVI) and daily handover (NCCC) 118 patients (only 5 through RVI) –84 (71%) were actually neutropenic –68 (57%) were haematology patients, 50 (43%) were oncology patients 112 patients were assessable for time to antibiotics –6 paper kardexes missing –transition to electronic prescribing in this period

One hour to antibiotics audit 83 patients (74%) had appropriate 1st-line antibiotics within 1 hour median time to antibiotics37 minutes mean time to antibiotics57 minutes reasons for antibiotics not being given within the 1 hour target –late prescription11 “waiting for FBC”, “delay in e-prescribing”, “risk not appreciated” –late administration5 –unclear13 use of gentamicin –received60% –not given40% (renal impairment, myeloma, recent cisplatin, other)

One hour to antibiotics audit date of audit Jan 2010July 2010May 2011Jan-June 2012 number of assessable patients number who received antibiotics within 1 hour 8%59%56%74% mean time to antibiotics (minutes) median time to antibiotics (minutes)

One hour to antibiotics audit previous successful strategies –establishing the 1 hour target –education focussed on NCCC junior staff and nurses action plan from this audit –further education in acute areas and NCCC recognising at-risk patients awareness of protocol neutropenic sepsis protocol importance of the 1 hour target not waiting for FBC result if neutropenic sepsis is suspected –“admit” patients on to eRecord immediately to avoid later delay in prescribing –repeat audit in 2013

Current service Acute Oncology Service, delivered by –NCCC:established consultant oncologist & haemato-oncologist on-call rota –RVI & FH:AOS nurse specialists and AOS consultant Local Trust CUP assessment service –in-patient:next working day review, delivered as part of AOS role –out-patient:review within 2 weeks, delivered through single weekly clinic with input from medical oncology and palliative care consultants, plus nurse specialist –(no CUP MDT yet) MSCC co-ordinator service (being piloted) –joint rota between Neuro-oncology Specialist Nurses, Oncology SpRs –single contact number –MSCC senior clinical advisor rotas in place Radiotherapy, Neuro-surgery, Neuro-radiology (no Spinal Surgery rota with Orthopaedics yet)

Achievements and Challenges AOS –over 350 referrals to date –rapid integration into acute pathways throughout Trust –improved quality of referrals through education, teamwork and visibility –secured substantive funding for AOS Consultant and Nursing posts  maintaining service during 6 month staff shortage  need to re-establish AOS presence again once fully staffed, more integration with NCCC  implementing a RAPA system CUP –nearly 100 referrals in 18 months –primary site identified in approx 50% of referrals –opened and recruiting to national CUP-1 study  preparing for CUP peer review  establishing a full CUP team and MDT meeting MSCC –establishing a Trust pathway –identifying and training MSCC co-ordinators –securing out-of-hours MRI on both hospital sites  piloting the service, collecting audit data