Introduction
Neutropenic fever (NF) is the most common complication of anticancer therapy and is a subset of patients with sepsis. While neutropenic fever guidelines require the presence of fever, up to 30% of patients with severe sepsis will be afebrile. With severe sepsis mortality rates of up to 25%, this may lead to the under recognition of neutropenic patients at risk1. WCMICS is undertaking a project to standardise the management of NF across their six hospitals. The goals of the project are to optimise patient health outcomes and their experiences of NF and to improve institutional efficiencies in the management of NF.
Methods
A detailed gap analysis was performed across the hospitals with the aims of;
- identifying concordance with the national published consensus guidelines for the management of NF2;
- to compare practices between sites;
- to establish whether sepsis management principles were included in the NF guidelines.
Results
While there was good concordance with antibiotic management, there were differences in definitions of NF (temperature and/or neutropenia) and importantly while institutional guidelines made reference to the ‘unwell’ patient or the ‘clinically unstable’ patient, no guideline included evidence based recognition and management of patients meeting the criteria for sepsis.
Conclusion
At the first project steering committee meeting consensus was readily achieved on definitions of fever and neutropenia, initial investigations and antimicrobial management. There was unanimous support for the inclusion of sepsis management guidelines based on the principles of the Sepsis Kills initiative from the Clinical Excellence Commission of NSW3. Each WCMICS hospital is now in the process of implementing a clinical pathway for the management of sepsis and/or neutropenic fever in cancer patients. In two WCMICS hospitals, senior nurse led model of care is being introduced for the management of low risk neutropenic fever.