The implementation of a Patient Group Directive for managing Febrile Neutropenic Sepsis met and exceeded its aims and objectives.

The NICE guidelines for Neutropenic Sepsis [CG151: Neutropenic Sepsis: prevention and management in people with cancer. 2012] recommend a door to needle time of 60 minutes for
administration of intravenous antibiotics to Oncology and Haematology patients with suspected
Neutropenic Sepsis.

Initial Audit:
A baseline audit in the department showed that only in 38% of cases were targets being met of administering antibiotics within the crucial time period of 60 minutes.

Possible Causes:
Paucity of junior doctor cover out of hours.
A gap in the lack of the utilisation of the skills of the experienced senior nursing staff working in
Paediatric Oncology and Haematology that could help towards improving the care standards, safety
and efficiency of care delivery.

A multi-disciplinary work group involving Haematology Consultants, Nurses, Pharmacists and Microbiologists to initiate and devise a strategy to improve ward targets. A Patient Group Directive was created that would be nurse led and provide the ability for senior nursing staff to assess the patient and prescribe and deliver the first dose of intravenous antibiotics in a safe and controlled manner.

There needed to be a systematic and logistical policy that was safe for staff and patients and would provide points for when ‘red flags’ were met and immediate action was needed. The Febrile Neutropenic Pathway provided a step by step approach for clinical assessment and a comprehensive proforma that each patient had to meet to determine if it was safe for first dose antibiotic to be prescribed and administered by skilled senior nursing staff, or if the immediate attention was required by a doctor.

Follow Up Audit:
The conclusive summary of the findings revealed that there was a 100% compliance and
improvement with meeting targeted time of 60 minutes from door to needle on the ward.