Clinical audit tool: Neutropenic sepsis (2012)

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Audit support
Issue date: [Year]
Sort title of guideline
NIC! clinical guideline [""]
Neutropenic sepsis:
#anage#ent of confir#ed
neutropenic sepsis
Clinical audit tool
I#ple#enting NIC! guidance
2012
NIC! clinical guideline 1$1
%is clinical audit tool acco#panies te clinical guideline: &Neutropenic sepsis:
pre'ention and #anage#ent of neutropenic sepsis in cancer patients()
Issue date: 2012
%is docu#ent is a support tool for clinical audit *ased on te NIC! guidance) It is not
NIC! guidance)
Acknowledgements
NIC! +ould li,e to tan, te follo+ing people +o a'e contri*uted to te de'elop#ent
of tis clinical audit tool and a'e agreed to *e ac,no+ledged:
Sirle- .ing/ Yor, 0ospital N0S %rust
NIC! as adapted te action plan te#plate produced *- te 0ealtcare 1ualit-
I#pro'e#ent Partnersip (01IP) in teir te#plate clinical audit report)
National Institute for Health and Clinical Excellence
2e'el 13/ Cit- %o+er/ Piccadill- Pla4a/ 5ancester 51 67%8 +++)nice)org)u,
9 National Institute for 0ealt and Clinical !:cellence/ 2012) 3ll rigts reser'ed) %is #aterial
#a- *e freel- reproduced for educational and not;for;profit purposes) No reproduction *- or for
co##ercial organisations/ or for co##ercial purposes/ is allo+ed +itout te e:press +ritten
per#ission of NIC!)
Clinical audit tool: Neutropenic sepsis (2012)
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Neutropenic sepsis: management of confirmed neutropenic sepsis
clinical audit tool
%is docu#ent can *e used as a starting point for a local clinical audit pro<ect tat aims
to i#pro'e te #anage#ent of confir#ed neutropenic sepsis) It contains:
clinical audit standards
a data collection for#
an action plan te#plate)
%e audit standards and data collection for# can *e adapted to focus on a s#aller part
of te tool or e:panded to include oter local priorities)
%e audit could *e carried out in te follo+ing services: all areas +ere patients +it
suspected neutropenic sepsis #igt present)
%e audit sample sould include cildren/ -oung people and adults +it confir#ed
neutropenic sepsis) 3d'ice on o+ to decide on sa#ple si4e is a'aila*le on 01IP(s
+e*site)
%e audit standards are *ased on te NIC! clinical guideline for Neutropenic sepsis)
In de'eloping tis tool consideration as *een gi'en to te clinical issues co'ered *-
te guideline and te potential callenges of data collection) %ere #a- *e oter
reco##endations +itin te guideline suita*le for te de'elop#ent of audit standards
or an audit pro<ect)
3 baseline assessment tool is a'aila*le) %is can elp to co#pare practice +it te
guideline(s reco##endations and prioritise i#ple#entation acti'it-/ including clinical
audit)
%e audit standards in tis docu#ent include a reference to te guideline
recommendation numbers/ and an- associated NIC! =ualit- standard state#ents
and exceptions) !:ceptions not e:plicitl- referred to in te guideline can *e added
locall-/ for e:a#ple/ patients declining treat#ent)
NIC! reco##ends compliance of 100>) If tis is not acie'a*le an interi# local target
could *e set/ altoug 100> sould re#ain te ulti#ate ai#)
Clinical audit tool: Neutropenic sepsis (2012)
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3 data collection form sould *e co#pleted for eac patient) %ere is a section for
de#ograpic infor#ation tat can *e co#pleted if tis infor#ation is essential to te
pro<ect) Patient identifia*le infor#ation sould ne'er *e recorded)
@ollo+ing te audit te action plan template can *e used to de'elop and i#ple#ent
an action plan to ta,e for+ard an- reco##endations #ade)
Reaudit is a ,e- part of te clinical audit c-cle/ re=uired to de#onstrate tat
i#pro'e#ent as *een acie'ed and sustained) Ance a re;audit as *een co#pleted/
te shared learning database can *e used to sare te e:perience of putting NIC!
guidance into practice)
@or further information a*out clinical audit refer to a local clinical audit professional in
-our o+n organisation or te 01IP +e*site)
%o ask a !uestion a*out tis clinical audit tool/ or to provide feedback to elp infor#
te de'elop#ent of future tools/ please e#ail auditsupportBnice)org)u,
Advice from the Health "rotection Agenc#
%e 0ealt Protection 3genc- as pro'ided te follo+ing ad'ice a*out NIC!Cs
reco##endation on reducing te ris, of septic co#plications of anticancer treat#ent
(see reco##endation 1)2)1)1))
@luoro=uinolone prop-la:is is ad'ocated as *eneficial for so#e patients +it
neutropenia (see 3nti*iotic prop-la:is in neutropenic patients: ne+ e'idence/ practical
decisions)) 0o+e'er/ it raises 2 concerns:
fluoro=uinolone prop-la:is can contri*ute to selection of resistance/ particularl- in
!ntero*acteriaceae
fluoro=uinolones are associated +it te selection of Clostridiu# difficile)
3ttention sould *e paid to *ot ris,s)
Clinical audit tool: Neutropenic sepsis (2012)
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Colonisation +it resistant !ntero*acteriaceae sould *e e:a#ined at induction of
neutropenia and +ee,l- tereafter until prop-la:is is stopped) %e easiest #etod is
to plate a rectal s+a*/ or faeces/ onto 5acCon,e- agar/ and to place a 1 #g (tat is/
standard) ciproflo:acin disc on te first series of strea,s after te inoculu# pool) 3fter
incu*ation te plate sould *e e:a#ined for *acterial colonies +itin te ini*ition
4one) If gro+t is found/ te *acteria sould *e identified and teir anti*iogra#s
deter#ined/ since #an- fluoro=uinolone;resistant isolates are resistant to #ultiple oter
agents) %e results sould infor# initial e#piric terap- if te patient e:periences a
su*se=uent fe*rile episode) %i#e trends in resistance sould *e #onitored/ *ot in
indi'idual patients and +itin units)
3d'ice on te diagnosis of Clostridiu# difficile;related disease is pro'ided in Dpdated
guidance on te diagnosis and reporting of Clostridiu# difficile) %is ad'ice sould *e
follo+ed for patients +it s-#pto#s of diarroea)
Clinical audit tool: Neutropenic sepsis (2012)
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$tandards for Neutropenic sepsis: management of confirmed neutropenic sepsis clinical audit
Audit standard %uidance
reference
Exceptions &efinitions
'anaging confirmed neutropenic sepsis
1) %e patient(s ris, of septic co#plications is assessed *- a ealtcare
professional (+it co#petence in #anaging co#plications of anticancer
treat#ent) +itin 26 ours of presentation to secondar- or tertiar- care)
[See data collection for#/ =uestion 1]
1)$)1)1 None %e ris, assess#ent
sould *e *ased on
presentation features
and using a 'alidated
ris, scoring s-ste#)
2) %e clinical status of patients +it confir#ed neutropenic sepsis is
re'ie+ed dail-)
[See data collection for#/ =uestion 2]
1)$)?)1 None %is sould *e done *-
a ealtcare
professional +it
co#petence in
#anaging co#plications
of anticancer treat#ent)
?) 3ll patients +it confir#ed neutropenic sepsis a'e teir ris, of septic
co#plications reassessed dail- using a 'alidated ris, scoring s-ste#)
[See data collection for#/ =uestion ?]
1)$)?)1 None %is sould *e done *-
a ealtcare
professional +it
co#petence in
#anaging co#plications
of anticancer treat#ent)
6) Initial anti*iotics are not s+itced in patients +it unresponsi'e fe'er)
[See data collection for#/ =uestion 6]
1)$)?)2 3 E tere +as a clinical
deterioration
7 E tere +as a
#icro*iological
indication
None
Audit standard %uidance
reference
Exceptions &efinitions
$)Intra'enous anti*iotic terap- is s+itced to oral anti*iotic terap- after
6F ours of treat#ent in patients +ose ris, of de'eloping septic
co#plications as *een reassessed as lo+)
[See data collection for#/ =uestion $]
1)$)?)? None Geassess#ent sould
*e done *- a ealtcare
professional +it
recognised professional
co#petence in
#anaging co#plications
of anticancer treat#ent
using a 'alidated ris,
scoring s-ste#)
&uration of antibiotic treatment
H) Inpatient anti*iotic terap- is continued in patients +o a'e
unresponsi'e fe'er)
[See data collection for#/ =uestion H]
1)$)6)1 C E an alternati'e cause
of fe'er is li,el-
None
I) 3nti*iotic terap- is discontinued in patients +ose neutropenic sepsis
as responded to treat#ent)
[See data collection for#/ =uestion I]
1)$)6)2 None %is sould *e done
irrespecti'e of neutropil
count)
&ata collection form for Neutropenic sepsis clinical audit
3udit IJ: Se:: 3ge:
%e audit IJ sould *e an anon-#ous code) Patient identifia*le infor#ation sould ne'er *e recorded)
(hite 'ixed Asian or Asian )ritish )lack or black )ritish *ther
7ritis Kite and *lac,
Cari**ean
Indian Cari**ean Cinese
Iris Kite and *lac,
3frican
Pa,istani 3frican 3n- oter
etnic group
3n- oter +ite
*ac,ground
Kite and 3sian 7angladesi 3n- oter *lac,
*ac,ground
Not stated
3n- oter #i:ed
*ac,ground
3n- oter 3sian
*ac,ground
No +uestion ,es No Exception-
.NA.Notes
'anaging confirmed neutropenic sepsis
1 Kas te patient(s ris, of septic co#plications assessed
+itin 26 ours of presentation to secondar- or tertiar-
careL
2 Kas te assess#ent carried out *- a ealtcare
professional +it co#petence in #anaging co#plications of
anticancer treat#entL
? Jid te patient a'e teir status re'ie+ed dail-L
6
Jid te patient a'e teir ris, of septic co#plications
reassessed dail- using a 'alidated ris, scoring s-ste#L
$
If te patient ad an unresponsi'e fe'er/ +as te initial
anti*iotic s+itcedL
A . )
H
If te patient +as reassessed as *eing at lo+ ris, of
de'eloping septic co#plications/ +ere te- s+itced fro#
intra'enous to oral anti*iotic terap- after 6F ours of
treat#entL
&uration of antibiotic treatment
I If te patient as an unresponsi'e fe'er/ +as inpatient
anti*iotic terap- continuedL
C
F
If te patient(s neutropenic sepsis responded to treat#ent/
+as anti*iotic terap- discontinuedL
MCircle e:ception codes as appropriate)
Exception codes
A E tere +as clinical deterioration)
) E tere +as a #icro*iological indication)
C E an alternati'e cause of fe'er is li,el-)
Action plan for Neutropenic sepsis clinical audit
Action plan
lead
Na#e: %itle: Contact:
%e &3ctions re=uired( sould specificall- state +at needs to *e done to acie'e te reco##endation) 3ll updates to te action plan sould *e
included in te &Co##ents( section)
Recommendation Actions re!uired
(specif- &None(/ if
none re=uired)
Action b#
date
"erson
responsible
Comments.action status
(Pro'ide e:a#ples of action in progress/
canges in practices/ pro*le#s
encountered in facilitating cange/ reasons
+- reco##endation as not *een
actioned etc)
Change
stage
(see .e-)
Ken #a,ing i#pro'e#ents to practice/ organisations #a- li,e to use te tools de'eloped *- NIC! to elp i#ple#ent te clinical guideline on
Neutropenic sepsis)
/E, 0Change status1
1 Geco##endation agreed *ut not -et actioned
2 3ction in progress
? Geco##endation full- i#ple#ented
6 Geco##endation ne'er actioned (please state reasons)
$ Ater (please pro'ide supporting infor#ation)