NAOG Audit and Education Event

19th April 2013

South Tyneside District HospitalAOS Nurse Rebecca Thomas

Acute oncology service.

• 1 full time AOS Nurse, supported by chemotherapy unit, specialist nurses and lead cancer nurse

• Outside hours, senior nurses in EAU have a resource folder and bleep.

• Patients encouraged to speak to chemo unit during working hours.

• Electronic flagging system captures all patients with a history of cancer.

Service development Dec ‘12-Apr ‘13

• Patient information leaflet implemented for all patients receiving chemotherapy.

• Chemotherapy unit now using UKONS tool to triage calls from patients,

• PGD has been requested for first dose of Tazocin for patients with neutropenic sepsis (Application awaiting approval).

• Teaching has been carried out in key areas on Sepsis and MSCC

• Awareness of CUP and AOS service has been raised across hospital.

• Change in hospitals blood culturing policy to enable nurses to perform cultures as part of’ hour door to needle pathway’.

Audit information.

MSCC Disease related Treatment related Neutropenic Sepsis CUP0

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Graph to show AOS intervention Feb-Mar 2013

• 160 patients were captured by flagging system between February and March 2013.

• 26 patients required AOS intervention

0-7 days 7-14 days 14-21 days >21 days0

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16Graph to show length of stay following AOS intervention Feb-Mar 13

The AOS service has helped to reduce the length of stay of patients, specifically those with Neutropenic Sepsis and MSCC.

Neutropenic Sepsis Audit

• A retrospective audit was conducted on Neutropenic Sepsis Coded patients presenting to STFT between April 2012 and March 2012.

• 36 patients were captured in the audit.

• 5 patients did not have an oncological diagnosis

• 13 patients were not neutropenic

Neutropenic Sepsis cont.

• 18 patients had confirmed neutropenic sepsis.

• All but 1 case appeared to coincide with chemotherapy treatment.

• 4 patients out of 18 were given antibiotics within an hour of presentation. (22%)

• Time to antibiotics was at best 30 mins and at worst 4 hours.

Neutropenic Sepsis.

• During the audit it became evident, patients were being triaged within the 30 minute target however waited on average a couple of hours for an antibiotic prescription.

• It is hoped that by increasing awareness amongst A+E staff, this will drastically improve.

• PGD for triage nurses also set to drastically improve on these results.

• Increased visibility of AOS nurse has already improved things significantly.