National challenges and local solutions
Neutropenic sepsis is a life-threatening complication of chemotherapy. It is a time-dependent medical emergency that requires urgent administration of broad-spectrum antibiotics. National guidelines require a maximum one-hour ‘door-to-needle’ time for antibiotic administration to patients presenting with neutropenic sepsis and Trusts must have a pathway for the rapid assessment and treatment of these patients. This evidence-based target has been shown to save lives.
To meet these requirements many Trusts in the UK, including the Royal Devon & Exeter NHS Foundation Trust, have implemented protocols that include the need for urgent white cell differential testing before urgent administration of IV antibiotics within one hour of admission.
Staff at the Cherrybrook Unit, Royal Devon & Exeter Hospital, recognised that there were several factors that could potentially cause a breach in meeting the one-hour target.
They also believed that the point-of-care HemoCue® WBC DIFF analyser offered solutions to these challenges.
The HemoCue® WBC DIFF analyser gives a 5-part differential of white blood cells with absolute count for each of the five subtypes (neutrophils, lymphocytes, monocytes, eosinophils, basophils) as well as the percentage distribution in minutes with just a finger-prick sample of blood.
Performance, accuracy and precision
Adopting any new approach requires evidence to ensure it meets requirements. The Royal Devon & Exeter haematology laboratory ran side-by-side tests to ensure the HemoCue® WBC DIFF analyser provided results equal to lab-standards.
This comparison concluded that the HemoCue® WBC DIFF analyser produced results comparable to the laboratory analyser. They also noted a number of further potential benefits the HemoCue® WBC DIFF analyser could bring, including prevention of inappropriate use of antibiotics and prevention of hospitalisations through early identification of neutropenic patients.
Outcomes
Helen Daggar, Matron of the Cherrybrook Unit says that the HemoCue® WBC DIFF analyser has been of significant value for patients with suspected neutropenic sepsis. The analyser is also helpful in terms of planning admissions. “Knowing quickly whether a patient has neutropenic sepsis speeds up the process of finding an appropriate bed in a side room to keep them in protective isolation.”
The HemoCue® WBC DIFF analyser has been an integral part of a multifactorial set of initiatives including staff education and the introduction of an acute oncology service. As a result, the achievement of door-to-needle targets has risen from 76% of patients in the year to March 2014 to 98% of patients in the year to March 2015.
Additional benefits for general chemotherapy patients
The Cherrybrook Unit has also seen benefits from the HemoCue® WBC DIFF analyser for general chemotherapy patients. The Unit aims to treat all patients with chemotherapy the same day as their consultant appointment. Using the HemoCue® WBC DIFF analyser for repeat WBC counts at the point of care provides an immediate result to inform the decision whether chemotherapy can safely go ahead; about 80% of patients are treated on the same day as they see the consultant. The remaining 20% are nurse-triaged without the need to see a consultant. The benefits for the patient pathway are clear with reduced patient waiting times and a more efficiently run Unit.
Future applications
Helen Daggar believes there may be further applications for the HemoCue® WBC DIFF analyser in the community setting, either via outreach centres or a mobile unit. She also feels that the analyser could be used more widely outside clinic hours and across other areas of cancer services at the Royal Devon & Exeter Hospital. Beyond oncology applications, the haematology lab has recognised potential uses in other areas such as psychiatric settings for patient prescribed clozapine.
