NHS unites to tackle sepsis

Professor Sir Bruce Keogh, NHS England Medical Director, has issued a rallying call to healthcare professionals across the country to focus on improving early recognition and timely treatment of sepsis.

At an event in London last night and ahead of a major new public awareness campaign delivered in collaboration with the UK Sepsis Trust, he set out the work that has been done so far to help nurses and doctors to recognise and treat sepsis and what more can be done to reduce deaths from sepsis.

Since April 2015 the number of people screened for sepsis has significantly increased, and it is now being diagnosed and treated quicker than ever before. However, one in four acutely ill patients is still not being tested early enough.

Anyone can develop sepsis after an injury or minor infection, although some people are at higher risk such as those with a weakened immune system, a serious illness, the very young or very old, or those who have just had surgery or wounds as a result of an accident.

Professor Sir Bruce Keogh said: “Doctors, nurses and other health professionals are spotting and treating more cases of sepsis than ever before, but there is still more we can do to reduce the number of families experiencing the heartache of losing a loved one from sepsis.

“Sepsis is a severe and life threatening response to infection which can be really hard to spot in its early phases. It is often preventable if an infection is identified early. But even when it has set in, it may be turned around if treatment is started soon enough.

“Sadly, many people still die from sepsis which is why we will be launching a public awareness campaign and introducing more measures than ever before to support and equip organisations and health professionals, to improve the chances of survival and reduce complications from sepsis.”

Sir Bruce also outlined the impact of measures for other conditions that have helped to reduce the number of deaths where health professionals united in a commitment to take action. These include; meningitis B immunisation for babies which has halved the incidence of the disease; specialist centres and networks improving the odds of survival from major trauma, stroke, heart attacks and an NHS wide systematic approach to assessing risk and preventative treatment for venous thrombo-embolism.

Nearly a year on from the launch of NHS England’s Sepsis Action Plan much has been done, but the next wave of activity is already underway and further measures to help support healthcare professionals to recognise and treat sepsis early are expected over the course of the next year.  These include:

  • The Secretary of State has committed to a package of support, to aid earlier diagnosis of sepsis in young children
  • Public Health England is working in partnership with the UK Sepsis Trust to deliver a campaign to help parents and carers of children under 5 to improve their knowledge of what sepsis is, the symptoms and when to seek urgent healthcare advice

Sir Bruce outlined further initiatives:

  • New incentives for hospitals, building on the introduction of previous financial incentives in 2015 – new 2017 guidance will be linked with those aimed at reducing antibiotic resistance
  • Improving consistency and transparency of reporting – NHS England intends to introduce a sepsis specific indicator to the Clinical Commissioning Group Improvement and Assessment Framework in 17/18.  The new ratings will provide a snapshot of how well different areas of the country are identifying and treating sepsis, showing areas in need of improvement, but also highlight areas of best practice for sharing amongst professionals
  • Distribution of new educational materials to support healthcare professionals – Health Education England have produced new education and training materials to increase awareness of sepsis amongst professionals.

Sir Bruce also called on health commissioners and providers to take local action to apply best practice aimed at improving sepsis diagnosis and treatment. These are:

  • Safety netting for GPs and parents: Some GP software companies have already introduced pop-up reminders and printed information for GPs to give to parents of sick children explaining what to look out for and when to bring the child back to be urgently seen again. All commissioned software, in all practices, should include such a package, to ensure the information is available consistently
  • Early Warning Score system: to improve the identification and treatment of sepsis across the whole patient pathway, all areas should use a consistent Early Warning Score to assess how sick patients are across the whole local health system – from hospitals, to ambulance trusts, to GP practices
  • Information on sepsis included in the ‘Red Book’: The personal child health record or Red Book is given to every new parent to keep track of their child’s health and progress. The Royal College of Paediatrics and Child Health has updated the national template to include information on how to tell if your child is seriously ill.

Bruce was joined on the stage by others including Dr Ron Daniels, Chair of the UK Sepsis Trust, Ruth May, Executive Director of Nursing for NHS Improvement and Celia Ingham Clark, Medical Director for Clinical Effectiveness at NHS England at an event to an audience of senior clinicians.

Dr Ron Daniels BEM, Chief Executive of the UK Sepsis Trust and global sepsis expert, said: “We’re delighted that our partnership with NHS England will deliver much-needed progress in sepsis awareness among healthcare professionals. This is a far-reaching and highly visible programme to ensure that professional development keeps pace with the huge strides we are making in improving public recognition of sepsis.

“Today’s initiative is a vital step in the right direction, but mandatory sepsis education courses must be introduced throughout the NHS and system-wide improvements to sepsis care must follow – we look forward to further collaboration in future. Clinicians can help save thousands of lives every year if they act quickly when they recognise sepsis.”

Professor Dame Sue Bailey, Chair of the Academy of Medical Royal Colleges, said: “This is a serious issue and the medical royal colleges have long been wholly supportive of Sir Bruce Keogh’s attempts to tackle the problem head on. While the early results are clearly making an impact, there is much more to be done to raise awareness of sepsis among all health service workers, patients and the wider public. Early diagnosis and effective treatment are key to success here and we must all redouble our efforts if more lives are to be saved.”

Dr Mark Porter, BMA council chair, said: “Sepsis is a disease where prompt recognition and management make a real difference, and moreover any healthcare staff can and should be trained to sound the alarm on sepsis. This is where raising awareness saves lives.”

Miss Clare Marx, President of the Royal College of Surgeons, said: “Thousands of people die every year from sepsis either because the signs are unrecognised or the treatment delayed. National co-ordinated action on sepsis is therefore long overdue and doctors must play their part in spotting the signs of sepsis early to allow faster commencement of treatment.”

The Royal College of Physician’s Future Hospital Programme officer Professor Frank Joseph, said: “The RCP fully welcomes this call to improve early recognition and appropriate treatment for sepsis. As health professionals we are in agreement, in both primary and secondary care, about how important it is to improve how we identify, diagnose and treat sepsis in order to reduce suffering and save lives. Sepsis is often hard to identify in its early stages and that is why it is essential that we, as doctors, seek out guidance, adopt recommendations and work in a way that enables us to really get better at dealing with this condition and improving patient care. With increasing winter pressures and more patients attending our A&E’s – we all need to ‘think sepsis’.”

Dr Carol Ewing, Vice President for Health Policy for the Royal College of Paediatrics and Child Health (RCPCH), said: “Sepsis is responsible for an estimated 37,000 deaths annually in the UK. Although relatively few children are killed by sepsis, the impact can be devastating. Key to preventing death is the early diagnosis and treatment but with a condition which can be difficult to identify, an education and awareness drive will be crucial if we are to avoid cases slipping through the net.

“The measures Sir Bruce Keogh outlined during his speech last night will be instrumental in supporting healthcare professionals to identify the early signs and enable them to act, Health Education England’s new education and training materials will be particularly relevant as will a clinical network approach to care where professionals and organisations  work together across a defined geographical  area  – this helps to bring  a  safe, standardised and equitable approach to care.

“As a college, we have updated the national template for the Personal Child Health Record to include information for parents on how to tell if your child is ill, and for health professionals, have recently launched Paediatric Care Online (PCO-UK) – an online decision support tool, providing specialist diagnostic advice to help ensure children get the right treatment at the earliest opportunity.

“To support this, I now urge paediatricians and all healthcare professionals to utilise the resources Sir Bruce has outlined. Collectively we can slow down the grip of this deadly disease and reduce the number of children who come face to face with it.”

Louise Silverton, Director for Midwifery at the Royal College of Midwives, said: “Severe sepsis can and does kill. Though it is rare, it can be catastrophic for pregnant and postnatal women.

“Sepsis remains a leading cause of maternal death. That is why it is so important that we do all we can to identify it as soon as possible so that it can be treated. It is also important not to forget newborn babies who can succumb to infection very quickly.

“Midwives should certainly “think sepsis” where there is deterioration in the health of either mother or baby. This means we need the right number of midwives so that they can deliver the best possible care, including in the postnatal period.

“Having the right numbers of staff will also help to ensure continuity of care and carer for women. Midwives who know the woman will be better equipped to spot changes in the woman’s condition and identify problems such as sepsis developing.”

Professor Helen Stokes-Lampard, Chair of the Royal College GPs, said: “Sepsis is a huge worry for GPs as initial symptoms can be similar to other common illnesses, and the College is putting a lot of effort into helping family doctors recognise potential sepsis and ensure that patients rapidly receive appropriate assessment and treatment.

“We have produced a toolkit, in partnership with NHS England,  which brings together existing guidance, training materials and patient information to encourage us all to ‘think sepsis, talk sepsis and treat sepsis’.

“We are pleased to be working with NHS England to raise awareness and improve outcomes for patients.  It really could save lives.”

Anna Crossley, Professional Lead for Acute, Emergency & Critical Care at the RCN, said: “Sepsis is a life-threatening condition and early identification is the key to survival, but it can be difficult to diagnose and often symptoms can be mistaken for a flu-like illness. This is why raising awareness among carers, health care professionals and the public is so vital. Even though there has been good progress to improve diagnosis, a cohesive national plan is needed to ensure that healthcare professionals are supported and equipped to identify and treat sepsis early.

“If sepsis is not recognised quickly, it can lead to shock, multiple organ failure and death, which is why early detection is critical to start treatment within the hour. Nurses and health care support workers, who see their patients on a regular basis, and are often the first healthcare worker to see them, are well placed to recognise the signs of sepsis early and raise the alarm. If a person has signs or symptoms that indicate possible infection, think ‘could this be sepsis?’ and act fast to raise the alarm, wherever you are.