Improving the Door to Needle time for Febrile Neutropenia

Partnership working between Heart of England NHS Foundation Trust (HoEFT) and

Pan Birmingham Cancer Network (PBCN)

Project team:Angela Allsop Clinical Educator HoEFTLynda Baker Haematology CNS HoEFT

Rebecca Pitt Oncology CNS HoEFTMarjorie Small Haematology Oncology Matron HoEFT

Marilyn Maynard Service Improvement Facilitator PBCN

National Driver National Chemotherapy Advisory Group Report August 2009

‘ bring about a step change in the quality and safety of chemotherapy services ...’

NCAG recommendationEnsure delivery of antibiotics occurs within one hour (i.e. “door to needle” times

for intravenous antibiotics or “door to swallow times for intravenous antibiotics) for patients presenting with neutropenic sepsis.

Local DriverMarch 2009 Network wide audit

Poor regional compliance

Definition and rationaleFebrile neutropenia is defined as • a patient with a neutrophil count <1.0 x109/l • temperature of >38.30C on one occasion, or greater than 380C on

two occasions more than 1 hour apart.

Patients with febrile neutropenia require• urgent assessment • commencement of intravenous antibiotics within 1 hour of

presentation.• Delay in administering antibiotics endangers life and is not

acceptable.

Taken from the Heart of England Management of Febrile Neutropenia Guideline

Where we started

• Reviewed current pathway– No defined care pathway– Patients seen in A+E but not prioritised – Patients at risk of death– Compromising patient safety

Out of Hours Pathway

Patient has a fever of feels unwell

Patient/ Carer becomes aware of symptoms and contacts the

Traige Bleep holder

Patient is traiged using the UKONS form

Patients and carer attend hospital. UKONS form shared

with receiving department

Patient is assessed

Patient is treated. Patient recieves IV Antibiotics

Patient admitted to a designated bed

Patients reviewed by a Doctor

Supported by

Compentcy based trainined, informed and skilled MDT

Electrinic Alerts

Improved access to guidelines

Redesigned alert card

Neutropenic Sepsis box

Single point of access

AuditTrained Triage Bleep

HolderCommunication with colleagues

from the Emergency team

QUALITY

Service Improvement• Baseline measurements• Data collection and review • Key stakeholder engagement• Process Mapping • Pathway analysis• Action planning• Lean tools• Problem solving and Innovation• Communication and Co production • Ownership and objectivity• Leadership

Sharing the learning

University Hospitals BirminghamNHS Foundation Trust-

training, alert card, electronic alerts and audit

Good Hope and Solihull HospitalsTraining and alert card

Walsall Manor HospitalAlert card, audit, electronic alert

Nationally

QuestionsWhat do you want to improve about your

service?

What elements of this work can you apply to

your area?

What is your first step?

Partnership working between Heart of England NHS Foundation Trust and

Pan Birmingham Cancer Network

Contactlynda.baker@heartofengland.nhs.uk

or marilyn.maynard@westmidlands.nhs.uk