Beating sepsis with early detection and prompt treatment

To mark World Sepsis Day Susan Aitkenhead, NHS England’s Director of Nursing, Professional Development, and Sarah Dodds, Director of Nursing at Weston Area Health NHS Trust, describe new work to tackle the disease and ensure better outcomes, experiences and use of resources:

Sepsis is a leading cause of death in the United Kingdom with a reported 44,000 cases every year.

We know that sepsis causes more deaths every year than breast, prostate and bowel cancer combined; 40% of cases relating to sepsis are severe and 50% of are related to septic shock.

Successful management of sepsis requires prompt recognition, appropriate interventions to identify and control the micro-organisms and restore oxygen delivery to tissues, and appropriate escalation and decisive medical management within the first hour of red flag sepsis.

We are delighted to publish this blog today, describing how the Lead Nurse for Deteriorating Patient and Sepsis at Weston Area Health Trust, James Merrell and Natasha Goswell, Director of Quality and Safety at the Trust, identified unwarranted variation in the rates of early detection and prompt treatment and addressed this through a number of successful and targeted interventions to improve patient outcomes and safety.

Leading Change, Adding Value (LCAV); a framework for nursing, midwifery and care staff is now in its’ third year of co-implementation. It continues to be a large system-wide example of successful partnership working with a wide range of national organisations and bodies representative of the health and care sectors, supporting all staff, whatever their role, wherever their work – to be leaders. By supporting colleagues to consider the outcomes of their work and question what impact their actions are having we are seeing a huge amount of work evidencing a measurable difference to experience, outcomes and the use of resources.

Weston General Hospital was making good progress in providing sepsis care but identified an opportunity to strengthen the sepsis care pathway, to not only save lives but to sustain improvements by using quality improvement methodology and integrating clinical governance.

Unwarranted variation was identified as a result of an audit in 2017, identifying the opportunity for improvement in the compliance and use of sepsis screening and delivery of the ‘Sepsis Six’ within one hour of red flag sepsis.

Sepsis Six consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of the initial diagnosis of sepsis. A baseline survey identified that the sepsis screening tool was not being used as well as it could be and survey results suggested there was an opportunity to ensure staff could become much more aware of sepsis, its signs and symptoms and treatments.

Multidisciplinary staff training was developed, empowering staff to support the clinical recognition of sepsis and the requirements of prompt action at the signs of sepsis.

An integrated nursing leadership programme was created, empowering nurses to escalate patients through the sepsis pathway more effectively, linked in with a newly created multidisciplinary team to provide more holistic care.

The introduction of NEWS (National Early Warning Scoring) also enables staff to utilise a validated assessment tool, supporting the identification of any patient who may have sepsis, and trigger the appropriate sepsis pathway which includes the ‘Sepsis Six’ stepped treatment model.

The work has also led to the creation of on-going awareness campaigns. One particular campaign has resulted in lift doors within the Trust now displaying full-height posters encouraging patients and visitors to ask themselves, and to ask hospital staff, ‘Could it be sepsis?’ Sepsis awareness is also built into the Trust staff induction.

Work continues, however, and since September 2017 there has been a significant increase in the use of the sepsis screening tool; from 17% to 96% by January 2018. In the emergency department, screening for sepsis is over 90% and administration of IV antibiotics within one hour is at 89%. Sepsis screening and treatment for inpatients has reached 100%.

For sepsis, the average length of stay at Weston General Hospital has reduced from eight days in October 2017 to four days in May 2018, which is well below the national average length of stay of 12 days. Clearly, addressing unwarranted variation in this way has led to better outcomes and experiences for patients.

Feedback has identified that staff at the Trust are recommending the sepsis training to colleagues and feel confident in using the training in practice. Educational sessions have provided staff with the knowledge to identify and pre-empt interventions and encouraged them to prompt colleagues in decision-making. One member of staff set up study days on their ward for their own specialty, which also includes sepsis care. Anecdotal evidence and experiences from patients and families have also been positive and sepsis support groups have also been set up for patients, post discharge.

Initiatives used throughout the Trust have been low in cost, using simple solutions that provide a standardised measurable response to sepsis and increase the compliance with the delivery of the ‘Sepsis Six’ by using NEWS and the sepsis screening tool.

By recognising and treating sepsis early, intensive care admissions, treatment and length of stay costs are reduced.

Susan Aitkenhead

Susan Aitkenhead is a Deputy Chief Nursing Officer to Ruth May, Chief Nursing Officer for England and supports CNO on matters linked to professional regulation, education, research, and collective leadership. This is in addition to the work with ministers, government officials, professional regulators, royal colleges, professional bodies and the Devolved Administrations to help shape policy and decision making.

Susan was previously a Director of Nursing at NHS England leading on a range of work aligned to system and service transformation at national, regional and local levels.

Susan is a registered nurse with extensive clinical, operational and strategic experience within healthcare across a variety of settings; and provider and commissioning executive and non-executive Board roles within both the UK and overseas.

She has also worked in a variety of other national roles such as at the Department of Health providing advice and support to ministers and policy officials across central government departments, and in professional regulation across the UK at the Nursing and Midwifery Council.

Twitter: @SAitke

Sarah Dodds

Sarah has been the Director of Nursing at Weston Area Health NHS Trust since February 2018.

Prior to this role, she was the Deputy Director of Nursing at North Bristol Trust. She has worked in a variety of senior nursing roles at both University Hospitals Bristol NHS Foundation Trust and the Royal Devon and Exeter NHS Foundation Trust.

Her clinical experience has been in Respiratory Medicine and Emergency Care.