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 become critically ill 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 outside of the hospital setting while they are at home. This means that patients need to know how to recognise the early signs of 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 fund a nurse-led project which explored knowledge, experience and clinical practice relating to neutropenia and infection in the cancer centre. This multi-step project included:
  • a case note review exploring presenting symptoms, including temperature, and their relationship to outcomes 
  • interviews with staff regarding their knowledge and clinical practice 
  • interviews with patients about their understanding of neutropenia and infection and their actions with regards to self-monitoring and seeking advice 
  • an audit of practice against treatment guidelines 
The findings of the review, revealed discrepancies between our interventions, 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

 Please find the full report here.