The Acute Oncology ServiceWhere we are now

Presentation by: Alison East Macmillan AO CNSDate: April 2013

One hour to antibiotic audit (11-3y-309)

Time period – October 2011 - April 2012 – 6 months

Patients treated with neutropenic sepsis • 16 cases reviewed and audited

(Dr A Nicolle Cons Haematologist)

Places where patients with Neutropenic sepsis were treated • A&E• MAU• Chemotherapy Day Unit (CDU)

Proportion that received antibiotics within one hour of arriving in hospital

• 37.5% n=6• 4/4 received antibiotic on CDU within a PGD

(100%)• 2 received antibiotic in A&E

Issues identified • Improvement being seen promptly by a Dr in

A+E• CDU nurse led PGD and medical review

occur in one hour• A&E time delay from AB prescribed and

administration by nurses• 4/16 patients were prescribed tazocin TDS

instead of the QDS

Local action • Results shared with emergency

departments/relevant teams• Visible red alert on patient PAS

record • Triage Tool generated when

patient attends A&E• Additional training arranged for

A&E/MAU/Acute Response Team ART

• Immediate Triage tool assessment in emergency care areas

• Importance of 1hour A/B time emphasise

• Trust wide launch of NICE guidance

• Extend PGDs• On going audit • Use of DATIX risk management

reporting

Breakdown of the data

Diagnosis Number of Patients (n=16)

Haematology patient - chemo

5

Haematology patient – no chemo

2

Lung cancer 3

Breast cancer 5

Rectal cancer 1

Chemo day unit

Medical Admissions

A+E

Less than 1 hour

4 - 2

1 – 2 hours - - 2

2-3 hours - 1 -

3-5 hours - 3 2

Timing unavailable from notes

- - 2

24 hour triage toolkit• Chemo Day Unit• Acute Response Team OOH

24 hour advice line LIVE May 2013

• A & E part of admission assessment planned

• MAU • Proforma developed to

form part of the patient Electronic Medical Record

• All triaged calls followed up by AO CNS or Haem CNS

Existing Alerting System REACT

Patient Administration System (Medway)

PAS BI DB

Medway Interface(Sender)

Trust Integration Engine (Ensemble)

PatientWatch list

Medway Interface (Receiver)

 RE

ACT

Phas

e 1

(EXI

STIN

G)

Alerting Engine

Live PAS DB

REACT Phase II

Escalation EngineMonitors unaccepted alerts and re-

raises if they have not been accepted within a given period

Rejected workflow

* User must specify a reason or comment

* The date, time, name of the user, and a mandatory comment are recorded and the alert is closed

Accepted workflow* Upon acceptance the date, time and name of the logged in user are logged.* Data about the patient will be brought from the Dendrite and/or Medway system (C-diagnosis, date of last treatment, pro forma status)* Compliance check-box of steps to act as a work list*Completion step includes “email summary to:” action

REACT User Interface (Secure web application)

REAC

T Ph

ase

2 (P

ROPO

SED

)

Overview screen

This screen will show all active alerts in one panel, and a list of the most recently closed alerts in another panel.

Symbols/icons will be used next to each alert to progress towards completion of a work flow.

Alert management* Shows an overview of all ‘open’ alerts* Allows ‘Accept’ or ‘Reject’ for new alerts

DB

Optional ModulesRE

ACT

Opti

onal

Ext

ras Built-in Reports (inc Audit viewing)

A number of formatted exportable and printable reports will be built in to the system and accessible from the front end. This would include summary data (i.e. compliance with 24 hour target) and audit viewing (who did what, and when?).Without this, reports would need to be generated by the informatics reporting team separately to the proposed solution.

Active Directory Integration

You can use the same login and password you use to log in to windows/email. This will allow the IT service desk to create new users for the system (by adding them to a group)

Without this, usernames and passwords will be created by an administrator and each user would have a new login for this system.

ANY QUESTIONS