"Mixed experience in the emergency department"

I was recently admitted by ambulance with suspected neutropenic sepsis, I’m currently having anti-cancer treatment (chemotherapy) for breast cancer. On arrival I was taken to resus, staff were concerned about my risk of infection due to possible neutropenia and tried to isolate me away from other patients, which was much appreciated.

One of the doctors was excellent. He explained about neutropenic sepsis. I explained I had a card which details that I should have certain antibiotics immediately (the paramedics were informed of this too). They confirmed they could see this on system.

They struggled to get a cannula in due to my poor venous access, I did have a PICC line however, this was not to be used. Unfortunately after several attempts it was unsuccessful and he went to get an ultrasound machine to help. This was in use. therefore I had to wait.

They sought help from another doctor who was fantastic. Very reassuring as I was extremely nervous about needing to get the line in for treatment. There were several attempts with the ultrasound machine however, finally successful. The medical staff offered constant reassurance. They were able to take off some bloods for sending to the lab but were unable to obtain blood cultures peripherally. My PICC line wasn’t cultured in A&E either.

I believe IV fluids were prescribed but I did not get these prior to IV antibiotics.

I was advised later whilst in ward that my temperature was raised in the Emergency department but I was not offered paracetamol until at least 7:00 pm (more than an hour after arrival). I had advised the team I felt hot and sweaty.

Antibiotics were prescribed and I had to wait I believe over an hour for these to be administered from prescription, in total approx 3 hours from being in the ambulance.

I could hear the nursing staff saying they were unsure how it was made up, and they were looking on the computer to gain this information. I also heard from nursing staff that this was one that people can react to. The nursing staff advised one of the antibiotics takes a while to dissolve therefore this was the delay, however I don’t understand why the other antibiotic wasn’t administered while waiting.

The night shift staff came on duty. Gary and Leah were fantastic, they created an instantly calm environment and Gary provided reassurance regarding the antibiotics and how I would be monitored.

In my opinion there are learning opportunities here.

1. It would be helpful to source another ultrasound machine for the department

2. The awareness of the importance of prompt delivery of antibiotics in suspected neutropenic septic patients

3. Creating an environment that’s reassuring

4. Prompt delivery of IV fluids and medication such as paracetamol in someone who is pyrexial.

5. Prompt blood cultures as this increased hospital stay by 1 night as the results were not known

I have fed this back to oncology team also to gain an understanding of why I went to Emergency department and not straight to ward 32. I am of the understanding this was due to the chest pain I was experiencing.