Neutropenic Sepsis One Hour Door-To-Needle Target in the Emergency Department: A Clinical Audit During the Covid-19 Pandemic


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Jonathan Martin1, Claire Pettinger2, Benjamin Mckechnie2, Lee Grimes2, Simon Hunter2, Margaret Pople2, Effie Grand2
1University of Southampton, 2Salisbury NHS Foundation Trust

Abstract

Background

Neutropenic Sepsis (NS) is a potentially life-threatening complication of chemotherapy/immunosuppression and is defined as pyrexia >38° C or signs/symptoms of sepsis, in a person with a neutrophil count of <0.5 X109/L. NICE Clinical Guideline (CG151) recommends that any patient with suspected NS should receive the sepsis six bundle (including IV Tazocin) within the first 1 hour of recognition. We aimed to evaluate our compliance with CG151 in Salisbury Emergency Department (ED).

Method

We implemented two PDSA cycles (plan, do, study, act) to audit our compliance to NICE GC151. We initiated a teaching session intervention after the first cycle, to address issues that had been highlighted in that cycle, and then re-audited our compliance.  We reviewed the electronic patient records system (Lorenzo) and the oncology patient alert system to identify patients with suspected NS who were admitted via ED.

Results

In our first PDSA cycle we identified 12 patients with suspected NS assessed in ED between August 2019 to November 2019. It showed that 42% were given IV antibiotics within the 1-hour target and 58% were given the correct antibiotic(s). We then implemented an educational session for new ED junior doctors in December 2019, emphasising early correct antibiotic use. Our second PDSA cycle was heavily disrupted by the Covid-19 pandemic in ED. We identified a further 46 patients between December 2019 to February 2021. 33% were given IV antibiotics within the 1-hour target and 59% were given the correct antibiotic(s).

Conclusion

Our findings indicate that we need to improve the management of suspected NS patients in ED. Although patient numbers are small, the data show that our 1-hour target compliance has decreased between 2 PDSA cycles (33% vs 42%) however our delivery of the correct antibiotics was similar (59% vs 58%). It is clear that the Covid-19 pandemic placed an unprecedented pressure on emergency services which made NICE compliance, further interventions and data collection challenging.

Impact statement

This clinical audit has highlighted that ED compliance with the 1-hour door to needle time for IV antibiotics in NS decreased during the Covid-19 pandemic, and has highlighted improvements to be made in NS management in ED.