1. NWLH NHS Trust Chemotherapy Lead Nurse/Matron
Chemotherapy Door to Needle Neutropenic Sepsis Audit (Haematology patients only) May 11 –Oct 11
Baleseng Nkolobe
NWLH NHS Trust Chemotherapy Lead Nurse/Matron

2. Auditors Audit lead: Baleseng Nkolobe
Other staff carrying out the audit:
Mary Collins
Caroline Kieley
Vashti Ragoonanan
Lead Consultant: N. Panoskaltsis

3. Scope of the Audit Trust site specific: Following NCAG report and N.S.
Northwick Park Hospital and CMH
Following NCAG report and N.S.
6 Monthly audit
Speciality
Haematology patients treated on the:
Haematology Unit NPH
Day-care Unit CMH
Chemotherapy Out Patient Unit NPH

4. Background
The aim of this audit is to measure how long (time) patients receive antibiotics from the time they are assessed by medical/nursing team and diagnoses of neutropenic sepsis is made in an emergency unit in NWLH NHS Hospitals.
As stated in the measures for AOS Peer Review Measures “a patient should enter a pathway from the time the neutropenic sepsis diagnosis is made… admission to the pathway does not require confirmation by blood test” measure 11-3Y-308

5. Standard Being Audited and Results from Last Audit
Patient Safety – time from neutropenic sepsis diagnoses by medical / nursing staff to 1st dose of IV antibiotics
Results from last audit
33% of patients were seen in the haematology assessment room.20% were treated within an hour of assessment by nurse/medical personnel compared to 40% in previous six months
60% were seen in NPH A+E and 33% of patients who attended A+E were treated within 1 hour
6% was seen in CMH A+E (1/15) and treatment within an hour was not achieved
Overall there was an improvement of 5% from last audit as 27% of haematology patients were treated within an hour.
The longest wait for antibiotics was 9 hours in A+E compared to 6 hours in haematology assessment room

6. Aims
To measure time from diagnoses of neutropenic sepsis to first dose of IVABS comparing it to Sept 10 audit.

7. Actions Agreed and Dates
Action Lead
Target
completion date
N.S. DVD for haematology unit to improve teaching re-management of N.S.
B. Nkolobe Chemotherapy Lead Nurse
Dec 2010
done
To discuss audit of in-patients developing N.S.
K.Kyriakou Haematologist
J.Lucas Haem unit Matron
Outstanding
May 12
Discussed at Cancer Board meeting
B. Nkolobe
2011
Re-audit required
B. Nkolobe;Chemotherapy Lead Nurse
October 2011
Please note, this slide is to inform your areas that actions will be taking place and in the re-audit these actions may probably show a change.
Note possible date/ month of the Re-audit.

8. Methodology Only 5 patients episodes were audited
Retrospective audit using formulated criteria for collecting data and also PAM-T patients from October 11
Data collected from information from medical notes and EPR timeline viewer
15/15 patient episodes were audited across 14 different patients
11 patients through PAM-T were audited and 9 excluded as reason for admission was not neutropenic sepsis
1 patient from CMH A+E was also excluded in time to IVAB`s as prescription could not be located for time confirmation
Only 5 patients episodes were audited

9. Regimen & Number of Episodes
Azacitidine+AML16 1
Rituximab+ Fludarabine and Cyclophosphamide 2
R-CHOP
BEACOPP
Cyclophosphamide and Dexamethasone
1 excluded as no script to analyse time for IVABS

10. Age Range Indicate on this slide as to why this audit was carried out.
No of patients
Indicate on this slide as to why this audit was carried out.
Example is it: National, regional, trust wide, Trust site specific, Nice Guidance,Patient involvement
Essence of care (Essence of care standards). An audit should be carried out to ensure that there are no gaps between actual practice and Best practice

11. Arrival Point
No of patient episodes
6 patient episodes but CMH patient only included in arrival point not in time to IVABs
Indicate on this slide as to why this audit was carried out.
Example is it: National, regional, trust wide, Trust site specific, Nice Guidance,Patient involvement
Essence of care (Essence of care standards). An audit should be carried out to ensure that there are no gaps between actual practice and Best practice

12. Time To IVABS
No of patient episodes
Indicate on this slide as to why this audit was carried out.
Example is it: National, regional, trust wide, Trust site specific, Nice Guidance,Patient involvement
Essence of care (Essence of care standards). An audit should be carried out to ensure that there are no gaps between actual practice and Best practice

13. Results/Findings IVABs given 2 x Tazocin
1 x Tazocin+ Amikacin + Metronidazole
1x Tazocin and Metronidazole

14. Time To Admission
No of patient
Indicate on this slide as to why this audit was carried out.
Example is it: National, regional, trust wide, Trust site specific, Nice Guidance,Patient involvement
Essence of care (Essence of care standards). An audit should be carried out to ensure that there are no gaps between actual practice and Best practice

15. Length of Stay Average length of stay 19.5 days
No of patient episodes
Average length of stay 19.5 days
Indicate in this slide, as to
How did you select the audit sample… retrospective/ prospective?/ randomly/ shift patterns
what was the total sample size
were there any inclusion/exclusion criteria.
Did you just audit NWP/ CMH or both sites

16. Discussions & Recommendations
Regimen
Cycle no
Day of cycle
On oral antibiotics
CVAD
Azacitidine 6 15
Yes No
Rituximab+ Fludarabine +Cyclophos 8 12
BeaCOPP 3 17
R-CHOP 2 9
No info
Number of haematology patients admitted with neutropenic sepsis decreased by 33% this is despite the inclusion of patient data from PaM-T for only one month October 11.
1000% of patients were treated within an hour of diagnoses/assessment in haematology unit
67% of patients seen in A+E were treated within an hour and the longest wait was 2 hours compared to 9 hours in last six months.
Overall 80% of patients treated in NWLH-NHS Trust were treated within 1 hour of diagnoses/assessment this is an improvement from 27% in the last audit( April 11)
The average length of stay for the 5 patients was 19.5 days the longest stay was 71 days for a patient who was treated in less than 1 hour.
Recommendations: TO BE DISCUSSED AT CCS Group meeting

17. Feedback CCSG Meeting Feb 12 Haematology Clinical governance April 12
Cancer Board meeting
A&E Matron and Lead Consultant
NWLH NHS Trust Audit

18. Actions Agreed and Dates
Action Lead
Target
completion date
Teaching for A+E medical and nursing staff
As part of Acute Oncology Services teaching
FEB 12 date changed TBC
Neutropenic audit for in-patients
Haematology ward manager/matron
April 12
Introduction of neutropenic sepsis DVD for patients who are starting chemotherapy
Baleseng Nkolobe – Chemotherapy Lead Nurse
Re-audit required
B. Nkolobe; Chemotherapy Lead Nurse
Please note, this slide is to inform your areas that actions will be taking place and in the re-audit these actions may probably show a change.
Note possible date/ month of the Re-audit.

19. References http://www.macmillan.org.uk/
National Chemotherapy Advisory Group (2009) Chemotherapy services in England: Ensuring quality and safety
National Confidential Enquiry into Patient Outcomes and Death (2008)
National Cancer Peer Review Programme: Manual for cancer services. Acute oncology-including metastatic spinal cord compression (2011)