Excerpt

Guidelines are recommendations for the care of individuals in specific clinical conditions or circumstances - and these can include prevention and self-care through to primary and secondary care and on to more specialised services. NICE clinical guidelines are based on the best available evidence of clinical and cost effectiveness, and are produced to help healthcare professionals and patients make informed choices about appropriate healthcare. While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.

In 2009 when this topic was commissioned, clinical guidelines for the NHS in England, Wales and Northern Ireland were produced in response to a request from the Department of Health (DH). Before deciding whether to refer a particular topic to the National Institute for Health and Clinical Excellence (NICE) they consult with the relevant patient bodies, professional organisations and companies. Once a topic is referred, NICE then commissions one of four National Collaborating Centres (NCCs) to produce a guideline. The Collaborating Centres are independent of government and comprise partnerships between a variety of academic institutions, health profession bodies and patient groups. The National Collaborating Centre for Cancer (NCC-C) was referred the topic of the prevention and management of neutropenic sepsis in cancer patients in October 2009 as part of NICE's twenty-third wave work programme. However, the guideline development process began officially in September 2010 when sufficient capacity became available at the NCC-C.

Contents

• Foreword
• Key priorities for implementation
• Key research recommendations
• List of all recommendations
• Methodology
• Algorithm: Summary of recommendations
• 1. Epidemiology and service provision of neutropenic sepsis in England and Wales
  • 1.1. Introduction
  • 1.2. The epidemiology of neutropenic sepsis in England and Wales
  • 1.3. Current service provision for neutropenic sepsis in England and Wales
  • 1.4. Summary
  • References
• 2. Diagnosis of neutropenic sepsis
  • 2.1. Definition of neutropenia and fever
  • References
• 3. Information, support and training
  • 3.1. Information and support for patients and carers
  • 3.2. Training for healthcare professionals
  • References
• 4. Identification and assessment
  • 4.1. Signs and symptoms that necessitate referral to secondary/tertiary care
  • 4.2. Emergency assessment in secondary/tertiary care
  • 4.3. Assessing the patient's risk of septic complications
  • References
• 5. Reducing the risk of septic complications of anticancer treatment
  • 5.1. Preventing the septic complications of anticancer treatment
  • References
• 6. Initial treatment
  • 6.1. Timing of initial antibiotic treatment
  • 6.2. Empiric intravenous antibiotic monotherapy or intravenous antibiotic dual therapy
  • 6.3. Empiric glycopeptide antibiotics in patients with central venous access devices
  • 6.4. Indications for removing central venous access devices
  • 6.5. Inpatient versus outpatient management strategies
  • References
• 7. Subsequent treatment
  • 7.1. Changing the initial empiric treatment in unresponsive fever
  • 7.2. Switching from intravenous to oral antibiotic treatment
  • 7.3. Duration of inpatient care
  • 7.4. Duration of empiric antibiotic treatment
  • References
• Appendices
  • Appendix A. A cost-utility analysis of primary and secondary prophylaxis with G(M)-CSF and/or quinolones for the prevention of neutropenic sepsis
  • Appendix B. Abbreviations
  • Appendix C. Glossary
  • Appendix D. Guideline scope
  • Appendix E. People and organisations involved in production of the guideline
• Evidence review, search strategies, health economics evidence review and health economics plan
  • Definition of Neutropenic Sepsis: guideline chapter two
  • Information, Support and Training: guideline chapter three
  • Identification and Assessment: guideline chapter four
  • Preventative Treatment: guideline chapter five
  • Initial Treatment: guideline chapter six
  • Subsequent Treatment: guideline chapter seven
  • Appendix 1. Literature search strategies
  • Appendix 2. Health economics evidence review
  • Appendix 3. Health economics plan
• An assessment of need