1. Sunderland Neutropenic Sepsis Audit Melanie Robertson – Nurse Consultant Oncology

2. Excellence in Health putting People first Neutropenic Sepsis January 2012 to December 2012 Total Number of Patients with suspected Neutropenia – 137 Haematology 99 Oncology 38 Total Number pts confirmed Neutropenia – 103

3. Excellence in Health putting People first Neut Sepsis pathways Number of Pathways completed – 47 CHDU – 31 A+E -9 B28 – 7 AMU – 0 Number of Pathways not completed – 90 CHDU – 29 A+E – 35 B28 – 18 AMU – 8

4. Excellence in Health putting People first Antibiotics administered Antibiotics time administered from admission Within 1 hour – 71 (51%) 1-2 Hrs – 25 (18%) 2-3 Hrs – 6 (4%) 3-4 Hrs – 3 (2%) Documentation unclear or no time specified (for admission or antibiotics) – 32 (23%)

5. Excellence in Health putting People first Traffic light table JANFEB % MAR % APR % MAY % JUN % JUL % AUG % SEP % OCT % NOV % DEC % CHDU 60%100 % 66%29%50%0%100 % 25%100 % 45%86% B28 0% 63%50%0% A&E 100 % 0% 40%100 % 0%80%100 % 83% AMU 0% 100 % 0%50%

6. Excellence in Health putting People first Actions Updated neutropenic sepsis pathway Encourage use of Neutropenic sepsis pathway Integrate pathway to electronic health records Increased training to recognise neutropenic sepsis (medical induction training) CQUIN target – RCA for patients not achieving 1 hour target.

7. Excellence in Health putting People first Meditech v6

8. Excellence in Health putting People first Auditing and Measuring outcomes

9. Excellence in Health putting People first Auditing and Measuring outcomes Analysis of emergency re-admission rates of patients with a diagnosis of cancer – 2009 Patient re-admissions 1283 – 2011 Patient re-admissions 924 Analysis of average LOS of emergency re- admissions of patients with a diagnosis of cancer – 2009 Average LOS 6 days – 2011 Average LOS 5 days

10. Excellence in Health putting People first Emergency readmissions

11. Excellence in Health putting People first Emergency readmissions by tumour group

12. Excellence in Health putting People first Length of stay

13. Excellence in Health putting People first Length of stay by tumour group

14. Excellence in Health putting People first Auditing and Measuring outcomes Re-admissions audit – Specifically patients admitted within 30 days of planned chemotherapy 68% of admissions not via Oncology mean admission date following chemo administration was 9.8 days Around 80% of patients were Breast/Lung/Colon Around 70% were receiving palliative chemotherapy Commonly admitted after Course 1 (C4) Average LOS 6.5 days (2009) 5 days (2010)

15. Excellence in Health putting People first Next Steps Lung Acute Oncology Nurse Introduce RAPA tool to identify more patients / patients at earlier step e.g. A&E Develop further ambulatory pathways – Uncomplicated neutropenic sepsis – Hickman line infection AOS Nurse Practitioner education – Prescribing – ECG Interpretation – Radiology Interpretation Implementation of Advanced care planning (ACP) in Oncology Radiology requesting

16. Excellence in Health putting People first AOS training http://www.test.elearninglaboratory.co.uk/AO/story.html http://www.test.elearninglaboratory.co.uk/AO/story.html

17. Excellence in Health putting People first Thank You melanie.robertson@chsft.nhs.uk melanie.robertson@chsft.nhs.uk

18. Excellence in Health putting People first