Chasing the Golden Hour - Lessons learned from improving initial neutropenic sepsis management

Area of Science:

• Oncology
• Infectious Diseases
• Healthcare Management

Background:

• Neutropenic sepsis is a life-threatening complication of cancer treatment.
• A national target exists for administering antibiotics within one hour of presentation.
• Initial audits revealed significant delays in antibiotic delivery within the Belfast Trust.

Purpose of the Study:

• To improve the timely recognition and management of neutropenic sepsis.
• To increase the percentage of patients receiving first-dose antibiotics within the target one-hour timeframe.

Main Methods:

• Introduction of an integrated care pathway for suspected neutropenic sepsis.
• Implementation of a user-friendly care pathway following initial disappointing results.
• Utilizing ward-based documentation for continuous monitoring.
• Facilitating nurse-led prescribing and antibiotic administration via patient group directions.
• Conducting regular multidisciplinary education and improving access to guidelines.

Main Results:

• Baseline audit showed only 15% of patients met the one-hour target.
• Re-audits showed initial improvement to 62%, followed by a decline to 50%.
• Post-November 2013, consistently over 80% of patients met the target.
• Recent data (July 2016) shows 100% adherence, with 95% in October.

Conclusions:

• A combination of interventions led to significant and sustained improvements in meeting the one-hour antibiotic administration target.
• The standardized, coordinated approach ensures prompt and safe clinical care for neutropenic sepsis.
• These improvements aim to prevent complications associated with delayed treatment.