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Yang Jian Ong,1– 3 Nisha Sikotra,1,4 Janelle Prunster,1,2 Nicola Bailey,2 Jane Hadfield,2 Rosemary Smith,2 Rohen Skiba,2 Astrid Arellano,5 Eli Gabbay,1– 3,6 Timothy D Clay1,7,8 1Bendat Respiratory Research and Development Group, St John of God Healthcare, Subiaco, Western Australia, Australia; 2Department of Medical Teaching, St John of God Healthcare, Subiaco, Western Australia, Australia; 3The University of Notre Dame, Fremantle, Western Australia, Australia; 4Research Department, St John of God Healthcare, Subiaco, Western Australia, Australia; 5Department of Infectious Diseases, St John of God Healthcare, Subiaco, Western Australia, Australia; 6Department of Respiratory Medicine, St John of God Healthcare, Subiaco, Western Australia, Australia; 7Department of Medical Oncology, St John of God Healthcare, Subiaco, Western Australia, Australia; 8School of Medical and Health Sciences, Edith Cowan University Joondalup, Joondalup, Western Australia, AustraliaCorrespondence: Nisha Sikotra Tel +61 08 9382 9172Email Nisha.sikotra@sjog.org.auBackground: Febrile neutropenia (FN) is a medical emergency that requires prompt empirical antibiotic treatment. Logistical factors can hamper the timely delivery of antibiotics for patients with suspected FN.Aim: To determine our institution’s adherence to timeliness of antibiotic administration after the implementation of strategies following a previous audit.Methods: Two retrospective audits were performed. Patients were identified through hospital coding and data were extracted from medical records. Interventions following the first audit included targeted staff education; development of a “Febrile Neutropenia Box” and the establishment of an acute medical unit (AMU). Adherence to guidelines and the effect of interventions were compared.Results: Audit one: 72 admissions (January 2017–December 2017); audit two: 55 admissions (October 2018–October 2019). Median time to antibiotics and adherence to 60-minute administration target: audit one: 135 minutes (range 15– 5160; 11% adherence); audit two: 80 minutes (range 0– 2130; 45% adherence, P=< 0.001). In audit two, the admission ward was the major factor that reduced time to treatment – AMU: 43 minutes (range 0– 440; 70% adherence); oncology ward: 98 minutes (range 0– 2130; 40% adherence); other wards: 190 minutes (range 0– 750; 27% adherence) (p=0.028 for adherence).Conclusion: A gap in our routine care of FN was identified. We assessed the effects of several interventions. The most important intervention was the introduction of the AMU which allowed sufficient resources to address time critical tasks. Health institutions without an emergency department should consider similar pathways to ensure timely care for patients with FN. Auditing current practice and evaluating interventions are important.Keywords: febrile neutropenia, quality improvement, complications of cancer, clinical practice guidelines, FN

Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical- and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.

Durvalumab is a selective, high-affinity human immunoglobulin monoclonal antibody in a class called check point inhibitors, that blocks PD-L1 on tumour cells. Despite clinical success in increasing progression-free survival rates in patients with stage III non-small-cell lung cancer, durvalumab has been associated with immune-related side effects such as pneumonitis and colitis. We present a case of an 84-year-old woman with acral vasculitis presenting as blue toe syndrome, associated with prolonged use of durvalumab. After 1 year of fortnightly durvalumab therapy postchemoradiation therapy, the patient came in with a left blue big toe, and later developed bilateral livedo racemosa. The diagnosis of durvalumab-associated vasculitis was made and treatment with prednisolone was started with clinical improvement.

Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical- and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.

This article discusses the effect of the role of the modern matron on healthcare-associated infection (HCAI) and hospital cleanliness. The way the modern matron's role is developing is examined in relation to HCAI in a large acute NHS trust. As set out in Implementing the NHS Plan: Modern Matrons (Department of Health (DH) 2001), the role of modern matron includes a responsibility to lead clinical teams in the prevention of HCAI.