Page 139 - Hospital Authority Convention 2017

Service Enhancement Presentations

F3.7 Clinical Safety and Quality Service I 14:30 Room 421

Streamline Care Pathway for Cancer Patients at Risk of Febrile Neutropenia after Chemotherapy Treatment
Mak SSS 1,8 , Chan M 2,8 , Chang PW 1,8 , Choy YP 3,8 , Lai K 4,8 , Lee LH 5,8 , Leung C 5,8 , Ling WM 2,8 , Lo CK 3,8 , Ngan PL 6,8 , Wan
WM 1,8 , Wong MC 7,8 HOSPITAL AUTHORITY CONVENTION 2017
1 2
Department of Clinical Oncology, Prince of Wales Hospital, Department of Clinical Oncology, Pamela Youde Nethersole
4
3
Eastern Hospital, Department of Clinical Oncology, Princess Margaret Hospital, Department of Clinical Oncology, Queen Mary
6
5
Hospital, Department of Clinical Oncology, Queen Elizabeth Hospital, Department of Medicine, United Christian Hospital,
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Department of Clinical Oncology, Tuen Mun Hospital, Specialty Advisory Group of Oncology Nursing, Hospital Authority, Hong
Kong
Introduction
There is an exponential increase in the use of chemotherapy for cancer. A high proportion of chemotherapy treatment is
delivered in ambulatory setting. Neutropenic sepsis is a well known and life-threatening complication of chemotherapy due
to bone marrow suppression, which is predictable, preventable, and manageable that early, goal-directed resuscitation and
urgent administration of broad-spectrum antibiotics have proven benefits on the outcome.
Objectives
(1) To analyse and identify problems in the management of patients presenting with post-chemotherapy febrile neutropenia (FN)
in the emergency access as well as its impact on patient outcomes; (2) to develop solutions and streamline pathway; and (3)
to evaluate the impact after implementation of a clinical pathway for post-chemotherapy FN.
Methodology
This is a pre- and post-study of the impact of a clinical pathway for post-chemotherapy sepsis in malignancy patients. It took Tuesday, 16 May
place in six Oncology Centres of Hospital Authority that was supported by Oncology Specialty Advisory Group. A quality
improvement process and two retrospective chart reviews were conducted. The first survey was between November 2012
and September in 2013 of 207 patients identified being admitted to oncology wards due to FN and receiving chemotherapy
within one month. A standardised protocol was conducted to direct the flow of FN patients through emergency department,
as well as structured patient education and written information were developed to the identified “high-risk” patients to
facilitate a streamlined process for prompt identification and treatment. The second survey was between May and July in
2016 with 53 patient recruited in a similar way after implementation of new clinical pathway. Data collected in the second
survey (pathway group) was compared with the first survey which served as historical referents.
Results
Compared with referent group, pathway group had significantly more patients receiving chemotherapy alert card (15% vs.
64%, p<0.001), having blood culture done (26% vs. 77%, p<0.001) and having antibiotics given at emergency access (16%
vs. 66%, p<0.001). Pathway group were associated with a significantly shorter mean door-to-needle time (126 minutes vs.
266 minutes; p<0.001) and significantly more patients having antibiotics given within one hour (57% vs. 11%; p<0.001) than
referent group. Adverse outcomes including intensive care unit admission, disseminated intravascular coagulation, etc. were
reported in 8% and 5% patients of pathway and referent group (p=0.44) respectively. Mean length of hospital stay was seven
days in pathway (range 2-15) and referent group (range 2-53).

Conclusion
Implementation of pathway for the oncology centres and their affiliated hospitals can effectively shorten door-to-antibiotic
time to meet the international standard of care in neutropenic sepsis patients. The compliance rate was also high. We
proved that effective implementation of the care pathway is feasible across departments through excellent teamwork among
oncology and emergency nurses, physicians, pharmacists, etc.

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