1. Improving the Door to Needle time for Febrile Neutropenia Partnership working between Heart of England NHS Foundation Trust (HoEFT) and Pan Birmingham Cancer Network (PBCN) Project team: Angela Allsop Clinical Educator HoEFT Lynda Baker Haematology CNS HoEFT Rebecca Pitt Oncology CNS HoEFT Marjorie Small Haematology Oncology Matron HoEFT Marilyn Maynard Service Improvement Facilitator PBCN

2. National Driver National Chemotherapy Advisory Group Report August 2009 ‘ bring about a step change in the quality and safety of chemotherapy services...’ NCAG recommendation Ensure delivery of antibiotics occurs within one hour (i.e. “door to needle” times for intravenous antibiotics or “door to swallow times for intravenous antibiotics) for patients presenting with neutropenic sepsis. Local Driver March 2009 Network wide audit Poor regional compliance

3. Definition and rationale Febrile neutropenia is defined as a patient with a neutrophil count <1.0 x10 9 /l temperature of >38.3 0 C on one occasion, or greater than 38 0 C on two occasions more than 1 hour apart. Patients with febrile neutropenia require urgent assessment commencement of intravenous antibiotics within 1 hour of presentation. Delay in administering antibiotics endangers life and is not acceptable. Taken from the Heart of England Management of Febrile Neutropenia Guideline

4. Where we started Reviewed current pathway – No defined care pathway – Patients seen in A+E but not prioritised – Patients at risk of death – Compromising patient safety

7. QUALITY

8. Service Improvement Baseline measurements Data collection and review Key stakeholder engagement Process Mapping Pathway analysis Action planning Lean tools Problem solving and Innovation Communication and Co production Ownership and objectivity Leadership

9. Sharing the learning University Hospitals Birmingham NHS Foundation Trust- training, alert card, electronic alerts and audit Good Hope and Solihull Hospitals Training and alert card Walsall Manor Hospital Alert card, audit, electronic alert Nationally

10. Questions What do you want to improve about your service? What elements of this work can you apply to your area? What is your first step? work? it will

11. Partnership working between Heart of England NHS Foundation Trust and Pan Birmingham Cancer Network Contact lynda.baker@heartofengland.nhs.uk or marilyn.maynard@westmidlands.nhs.uk