Newcastle upon Tyne Hospitals NHS Foundation Trust

Audit results for NAOG meeting

19 April 2013

The Newcastle upon Tyne HospitalsNHS 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 antibiotics 37 minutes• mean time to antibiotics 57 minutes

• reasons for antibiotics not being given within the 1 hour target– late prescription 11

• “waiting for FBC”, “delay in e-prescribing”, “risk not appreciated”

– late administration 5– unclear 13

• use of gentamicin– received 60%– not given 40% (renal impairment, myeloma, recent cisplatin, other)

One hour to antibiotics audit

date of audit Jan 2010 July 2010 May 2011 Jan-June 2012

number of assessable patients

12 17 16 112

number who received antibiotics within 1 hour

8% 59% 56% 74%

mean time to antibiotics (minutes)

245 80 76 57

median time to antibiotics (minutes)

213 60 60 37

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