Download Acute Oncology

The Newcastle upon Tyne Hospitals
NHS Foundation Trust
Newcastle upon Tyne Hospitals
NHS Foundation Trust
Audit results for NAOG meeting
19 April 2013
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
AOS
 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
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
• mean time to antibiotics
37 minutes
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
– unclear
5
13
• use of gentamicin
– received
– not given
60%
40% (renal impairment, myeloma, recent cisplatin, other)
One hour to antibiotics audit
date of audit
Jan 2010
July 2010
May 2011
Jan-June 2012
12
17
16
112
8%
59%
56%
74%
245
80
76
57
213
60
60
37
number of assessable
patients
number who received
antibiotics within 1
hour
mean time to
antibiotics (minutes)
median time to
antibiotics (minutes)
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