Nayomi Shermila Jarasinghe

Queensland Health, Australia 

BIOGRAPHY

Dr.N.S.Jayasinghe is a senior registrar in internal medicine in Central Queensland Health Services. She possess 8 years of post graduate experience with MBBS and MD(internal medicine )degrees. She is an associate lecturer in University of Queensland.She was an author of many internationally published articles. She is actively involved in ongoing research in her working place. Her research interests are non communicable diseases, infectious diseases and hematolgy.



ABSTRACT

Have we taken it for granted”: An audit on adult febrile neutropenia in regional Australia

Nayomi Shermila Jayasinghe¹, Sudhakar Vemula²
1Department of Medicine, Rockhampton hospital, Queensland, Australia
2Department of Oncology, Rockhampton hospital, Queensland, Australia

Background: Febrile neutropenia (FN) is a main cause of mortality and morbidity around the world (Kuderer, Dale, Crawford, Cosler & Lyman 2006). Strict adherence to guidelines is vital to prevent adverse outcomes. Audits on febrile neutropenia in regional Australia are sparse. This is phase 1 of the study which will be followed by analysis of pitfalls to achieve better outcomes through recommendations and implementations.

Method: A retrospective chart review identified all consecutive patients admitted to Central Queensland Health Services with febrile neutropenia between August 2016 and January 2014. All adult patients meeting the definition of FN (therapeutic guidelines 2016) were included. Clinical characteristics, door to doctor time, door to needle time, choice of antibiotics and adherence to guidelines were analysed.

Results: Total n=84 events were analysed. N=77(91%) were related to malignancy and n=7(9%) were non-malignant cases. Antibiotics were given within 60 minutes in n= 33 (39.3%) events. Delay was more than 120 minutes in n=16 (19%) events. N=70 (83.3%) received antibiotics within 90 minutes seen by the doctor. Only in N=72 (85.7%) patients blood cultures taken before starting antibiotics. Full septic screening (full blood count, blood culture, Urine analysis, inflammatory markers and chest x-ray) was conducted only in N=65(77%) events on admission. N=7 (8.3%) events did not have 3 components of full septic screen at admission. N=2(2.7%) did not receive recommended antibiotic. N=7 (8.33%) did not receive Gram negative covering antibiotics when indicated.

Conclusion: Only 39.3% received antibiotics within the first 60 minutes of presentation. Delay of >120 minutes was seen in 19% events.14.2% did not have blood cultures before antibiotics. In 23% septic screen was incomplete. In 11.03% events choice of antibiotic has deviated from current guidelines. We recommend increasing awareness on neutropenia guidelines among medical officers. Phase 2 study would analyse the improvement following implementation of recommendations..