Authors (including presenting author) :
Tung KK, Ha CY, Chan KF, Wong YC, Lo ML, Chow PY, Mak CL, Mak HS, Siu PY, Yip SF
Affiliation :
Hematology Unit, Medicines & Geriatrics, Tuen Mun Hospital
Introduction :
Neutropenic sepsis is considered to be a potential life-threatening complication of chemotherapy. Mortality rates within the first 48 hours of infectious symptoms have been documented approximately 50%. Neutropenic sepsis can be rescued by prompt administration of intravenous antibiotic. According to International Standard, antibiotic should be started within one hour of admission.
Objectives :
To ensure timely administration of intravenous antibiotic to susceptible neutropenic septic patients from different clinical units before admitting to Hematology ward directly.
Methodology :
Key improvement strategies to prevent neutropenic mortality
(1) Enhance communication between AED and M&G -Since 2011, NTWC Guidelines for Management of Neutropenic Sepsis for Patients with Hematological Malignancies in the AED and M&G Departments had been endorsed.
(2) Broad spectrum intravenous antibiotic would be given at AED upon identifying neutropenic sepsis, targeting door-to-needle time within one hour.
(3) Chemotherapy Alert Card was issued to patient receiving intensive chemotherapy by Hematology nurse.
(4) Update latest chemotherapy course in Clinical Management System Alert by Hematology team.
(5) Pre-printed Integrated Sheet for emergency management of neutropenic sepsis in M&G.
(6) Commencement of “Antibiotic Optimization Program” (AOP) within TMH AED, Hematology clinic, and Hematology in-patient wards (F1/F2 ward) since 2016.
A retrospective study was conducted in Dec 2018 to assess the time of first dose antibiotic for patients admitted for neutropenic sepsis from 2011 to 2018 in two hematology wards, the data is analyzed in the following.
Result & Outcome :
In 2011, only 11% of patients received first dose of antibiotic within one hour. After the implementation of neutropenic sepsis program in 2012, the percentages of patient receiving antibiotic were 25%, 44% and 46% from 2012 to 2014 respectively. In 2015 & 2016, 70% and 82 % patients could meet the one hour target. In 2017 & 2018, more than 90% of patients could receive first dose of antibiotic within one hour. In conclusion,the study illustrates how the inter-departmental collaboration could significantly reduce the time for administration of antibiotic for Hematology Patients with Neutropenic Sepsis in different clinical units. The promising result confirms the efficiency of the program in which enhancing patient safety.
Co-location with:
