抗生素PPT课件（英文精品）Chemotherapy Out of Hours Triage Neutopenic .pptVIP

Chemotherapy Out of Hours Triage: Neutopenic Fever Jeanette Ribton Oncology CNS Project No: 26 08/09 Produced by: J Anders C-GARRD Presented: September 2008 St Helens Knowsley Teaching Hospital NHS Trust ~ CGARRD 2008-09  Why we needed to change: Case Study St Helens Knowsley Teaching Hospital NHS Trust ~ CGARRD 2008-09 Lung cancer ?early SCLC Potential remission 2 yrs + with treatment Co-morbidity ?Eaton Lambert (poor mobility) Pt given 1 cycle ?discharged home On day 8 - diarrhoea, unwell, low grade pyrexia Attended AE 1am - Hypotensive, Neuts 0.1, fluids administered Transferred to a ward Transferred on again Antibiotics given at 1 pm Patient died at 4 pm Background St Helens Knowsley Teaching Hospital NHS Trust ~ CGARRD 2008-09 Snap shot Audit (randomly selected patients 2005-07) Pre-pathway audit identified: Lack of inpatient beds Lack of awareness of care pathways in AE Poor communication across inpatient ward and AE Absence of IV antibiotics (for Neut sepsis) in AE Negative impact of 4 hour targets with patients moved off AE prior to treatment Delays in first antibiotic that exceeded 12 hours in several cases Delayed first antibiotic on cancer day unit due to lack of medical staff Background St Helens Knowsley Teaching Hospital NHS Trust ~ CGARRD 2008-09 A snap shot analysis illustrated: Time for a patient to see a Doctor ranged from; 53mins to 3hrs 8mins from arrival at AE Time to first administration of antibiotics ranged from; 3hrs 5mins to 12hrs from arrival at AE Initial actions St Helens Knowsley Teaching Hospital NHS Trust ~ CGARRD 2008-09 The process involved multi-professional collaboration through the oncology and AE departments to enable: The development of an alert card The development of an AE triage neutropenic sepsis pathway (integrated into the standard AE generic pathway) Immediate Full Blood Count First antibiotic administration in AE Bro