New NHS England action plan to help tackle ‘silent killer’ sepsis

A new action plan has been published today to help support healthcare professionals to recognise and treat sepsis promptly.

Sepsis is triggered by an infection, where the body’s immune system goes into overdrive, setting off a series of reactions that can lead to organ failure, and in some cases, death.

The number of people developing sepsis is increasing, with around 123,000 cases each year in England. An estimated 37,000 deaths are associated with the condition – this is more than the number who die from lung cancer.

Known as a silent killer, it can be extremely difficult to recognise and diagnose, but sometimes it can be prevented, and it is treatable in many cases.

However, the recent NCEPOD report highlighted that only a third of patients with sepsis received good quality care and the UK Sepsis Trust estimates that 10,000 deaths could be avoided each year through prevention or early accurate diagnosis and effective treatment.

Earlier this year NHS England brought together Royal Colleges, the UK Sepsis Trust and others to advise on how best to improve the recognition and treatment of sepsis. This new action plan sets out what we need to do to drive improvements for patients with sepsis, identifying and focusing on five key areas:

  • Preventing avoidable cases of sepsis – Some cases are preventable, particularly in at risk groups including older people, the immunosuppressed, pregnant women and children. In order to support this actions in the plan include:
    • NHS England, Care England and the National Care Forum to gather examples of best practice in care home sector with regards to UTIs and sepsis, and share the learning from this.
    • NHS England has published a continence framework outlining good practice, which can help to reduce the onset of UTIs – a major source of sepsis.
  • Increasing awareness of sepsis amongst the public and professionals – Treatment of sepsis is extremely time sensitive, so improving recognition could help save lives.  Actions include:
    • UK Sepsis Trust to develop ‘sepsis savvy’ microteaching sessions for parents and lay people to raise awareness, communication and social media outreach.
    • Public Health England is assessing the evidence base for a public awareness campaign on sepsis.
  • Improving identification and treatment of sepsis across whole care pathway to ensure that patients receive the care they need irrespective of the first point of contact with health services.  Actions include:
    • Care Quality Commission to look at how trusts are using evidence based guidelines once NICE publish guidance in 2016.
  • Improving consistency of standards and reporting – Much more robust information is needed on the true prevalence and associated burden of sepsis to inform future quality improvement initiatives.  Actions include:
    • NICE to publish clinical guideline in 2016 and quality standard in 2017
    • HSCIC to produce SNOMED code sets representing the standard/acceptable clinical phrases for sepsis following publication of new international definitions of sepsis
    • Ensuring appropriate antibiotic prescribing – It is imperative to ensure that principles of good antimicrobial stewardship and appropriate use of antibiotics are built into all activities, to ensure that antibiotics remain effective.
    • As evidence about the effectiveness of antibiotics in treating severe sepsis becomes clearer, organisations will look to refresh guidelines on antibiotic use to represent up to date, robust evidence.

Professor Sir Bruce Keogh, NHS England’s National Medical Director, said: “What is clear is that we all want to do better for this group of patients.

“In many cases sepsis is avoidable, and if not, it is often treatable, so we need to ensure that healthcare professionals are supported and equipped to identify and treat sepsis early.

“We have a good idea of what needs to be done and this plan aims to make things happen.”

Celia Ingham Clark, NHS England’s National Director for Reducing Premature Deaths, said: “Recognising the early signs of sepsis so that treatment can begin as quickly as possible will help save thousands of lives.

“As well as the publication of this action plan, we also have an ongoing programme to help educate clinicians around the early recognition and treatment of sepsis. Our focus is on early detection, getting patients the right treatment at the right time, and involving senior staff quickly when patients deteriorate, all of which will improve their chances of making a full recovery.”

Dr Ron Daniels, Chief Executive of UK Sepsis Trust, said: “As Chief Executive of the Sepsis Trust, I welcome this report and the excellent, wide ranging work undertaken by the NHS Cross System Programme Board. Building on foundations laid by the Sepsis Trust over the last decade, this report contains the essence of a transformational change in the way our healthcare system manages patients with sepsis. Along with appropriate investment, we now have real opportunity to drive improvements resulting in our saving an extra 10,000 lives every year.”

NHS England has already introduced a number of measures to help tackle sepsis, including working with PRIMIS to develop a voluntary audit tool for GPs to allow them to assess their care of children with fever against NICE guidelines, as fever can be a precursor to sepsis arising.  NHS England will initially be inviting those practices who are already using similar tools to download and use the tool in the New Year.

A patient safety alert has also been issued to highlight resources such as the ‘Sepsis six’ and ensure all NHS providers in England are aware of them.