Spreading the news about neutropenic sepsis: translating complex ideas into patient care
Neutropenic sepsis is a potentially life-threatening complication of chemotherapy.  Neutrophils are
white blood cells that play a fundamental role in fighting infection and patients who have a low neutrophil count (neutropenia) have increased susceptibility to infections and are less able to fight them (Warnock 2016). Neutropenic patients who initially appear stable can quickly deteriorate and patients with any symptoms suggestive of infection require urgent assessment and treatment (NICE 2012). The onset of neutropenia is typically 5 to 14 days after chemotherapy treatment so for most patients it occurs while they are at home.  This means they need to know how to recognise infection and then take action that includes contacting the local cancer centre for advice (Methven 2010).

At the hospital where this project was carried out a range of interventions have been developed and implemented regarding infection and neutropenia in patients receiving chemotherapy. Examples include written patient information, a neutropenic sepsis alert card, one-to-one pre-chemotherapy information consultations, staff training initiatives and a telephone advice service. In 2014 a grant was received from the Weston Park charity to evaluate staff and patient knowledge, experiences and clinical practice relating to neutropenia and infection in the cancer centre. The findings of the review, revealed discrepancies between intervention aims and outcomes. Examples included:

·         Variations in patient knowledge around temperature values and symptoms of infection

·         Variations in the advice staff reported they would give to patients

·         Inconsistent compliance with audited practice standards e.g. selection of treatment pathways, time to first dose of antibiotics

Of particular concern was the finding that some patients deviated from recommended advice and delayed contacting the cancer centre when they had an elevated temperature or other symptoms of infection.

The findings of the 2015 review provided the impetus for the GRIP project which aimed to gain further insight into the reasons behind variations in practice, particularly with regards to patient knowledge and advice-seeking behaviours and develop approaches to care that were effective in our local context.

The project aims were to

Ø  understand the factors that influence patient’s knowledge and actions regarding neutropenia and infection by exploring patient and staff experiences  

Ø  use these insights to create new approaches to care and information provision that might bridge the gap between practice, actions and outcomes

Ø  provide an opportunity for clinically based nurses to develop experience and skills in knowledge translation including data collection and analysis, product design and implementation.

 Please find the full report here.