BASILDON AND THURROCK HOSPITAL (Junior Doctor’s Handbook)

FAST TRACT ADMISSION FOR NEUTROPENIC PATIENTS

The following guidelines must be followed for patients presenting to Mary Wright/A&E with suspected neutropenic sepsis.

 ATTENTION MEDICAL SHO’s/REGISTRARS

 Main Points

1. Patients presenting with febrile neutropenia must be assessed, resuscitated and started on appropriated IV antibiotics within two hours of presentation.

2.  After stabilisation, they should be transferred to the designated Haematology Day Unit on Mary Seacole Ward or admitted preferably to a side room on Mary Seacole Ward.

3. Neutropenia is defined as neutrophil count <0.5 x 10⁹/l.

4. Patient groups presenting to Mary Wright unit or A&E:

                        Patient known to have acute leukaemia.
                        Patient with cancer, recently received chemotherapy.
                        New patient with unexplained neutropenia.

Plus

Unexplained pyrexia/generally unwell.

5.                  Immediate action on presentation:

Assess on Mary Wright Unit – Medical SHO/Registrar
Urgent FBC, U&E, CA, G&S, COAG, CRP profile
CXR blood cultures
Urine and stool cultures if indicated.

Consult handbook for appropriate antibiotics normally Ofloxacin 200mg bd iv to start.

6.                  Subsequent action:

                         Organise fast-tract admission to Mary Seacole Ward
                         Order red cell transfusion as appropriate
                         Order platelet transfusion if plate count <20 x 10⁹/l.
                         Contact Haematologist on-call for advice.

Consultants:            Dr Paul Cervi and Dr Eric Watts