nhs forth valley formulary 11 - Community Pharmacy

Forth Valley Formulary Eleventh Edition 2012/13Appendix 18SUSPECTED NEUTROPENIC SEPSISNEUTROPENIC SEPSIS CAN BE FATAL IF NOT TREATED PROMPTLY.PATIENTS WITH SUSPECTED NEUTROPENIC SEPSIS MUST BE ASSESSED, CULTURES TAKEN ANDANTIBIOTIC THERAPY STARTED WITHIN 1 HOUR OF ADMISSION (or onset of fever if already an inpatient).NEUTROPENIC SEPSIS SHOULD BE CONSIDERED A POSSIBILITY IN ANY PATIENT WHO HAS HADCHEMOTHERAPY WITHIN PREVIOUS 28 DAYS.PATIENTS SHOULD BE ADMITTED UNDER THE MEDICAL RECEIVING TEAM.Definition of Neutropenic sepsis:• Neutrophils 38 o C on one occasion or clear history of persistent pyrexia measured by patientprior to admissionOR• Clinical signs of septicaemia (tachycardia, hypotension, increased respiratory rate, rigor, alteredmental status, hypothermia)MANAGEMENTWITHIN 1 HOUR• Take brief history to establish potential for neutropenic sepsis and identify any drug allergies• Record baseline observations on Early Intervention Score Sheet• Establish venous access• Take peripheral blood cultures (and central line blood cultures if line present)• Take FBC, U+E, LFTs and CRP• Start IV fluids - 0.9% saline. Minimum rate 125ml/hr• Start accurate fluid balance monitoring. Patient may require urinary catheterisation for this to beaccurate.• Give first dose of antibiotics as per FV neutropenic sepsis antibiotic policyDO NOT WAIT UNTIL BLOOD RESULTS ARE BACKWITHIN 4 HOURS -Subsequent management presumes confirmation of neutropenia• Complete full history and examination. If the patient is being treated by a Beatson Oncologist furtherinformation can be obtained by contacting the on-call Specialist Registrar via Beatson Oncologyswitchboard on 0141 301 7000• Carry out full infection screen (MSSU, line swab, wound swab, throat swab, sputum sample, stool forC+S where appropriate)• Review blood results and ensure subsequent doses of antibiotics are prescribed and at correct dosefor renal function• CXR- if any respiratory symptoms or signs eg. cough, purulent sputum, decreased O2 saturation on air• Continue to record observations at minimum intervals of 4 hours or more frequently if clinicallyindicatedWITHIN 24 HOURS• Consultant should review patient within 24 hours of admission.• Repeat blood cultures if fresh temperature spike9• Identify single room and reverse barrier nurse until neutrophils >1.0 x 10 /LWritten by Dr. Marie Hughes, Consultant Haematologist, March 2010Review date: March 2012Page 86