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NHS England’s Medical Director for Clinical Effectiveness celebrates the progress made through the Cross-System Sepsis Board and discusses the challenges and objectives that lie ahead in tackling sepsis and saving lives.
Now the NHS Long Term Plan has been published; providing a blueprint for healthcare in England over the next ten years, I want to take the opportunity to reflect on the progress made to improve the identification, diagnosis and management of sepsis and ultimately, improve patient safety outcomes.
Successfully implementing sepsis within the CCG Improvement Assessment Framework in 2017/18, and providing a benchmark for how CCGs are prioritising sepsis education within their localities was a big step forward.
Last year’s results showed over 3/4 of CCGs are now prioritising sepsis in their commissioning arrangements, with nearly a third having a sepsis lead identified in more than 75% of practices. This is hugely positive. Operationalising guidance and strategic planning at local level and building set pathways for the identification, diagnosis and treatment of sepsis is crucial.
We’ve also made progress in improving education around infection, with sepsis now forming part of many curricular, and Health Education England has opened discussions with Skills for Care on dedicated training for care home staff. NHS England is continuing to work on reaching and engaging the community nursing workforce through the development of standard specifications for community health services.
We will continue to support work to improve outcomes for people with a learning disability with a specific focus on improving the identification of acute deterioration, including sepsis, and are actively supporting the Learning Disabilities Mortality Review Programme (LeDeR) to identify learning points and improvement initiatives as part of the new learning disability mortality review network. To hear more, or join the network please email firstname.lastname@example.org.
The roll out of National Early Warning Scores (NEWS2) in acute and ambulance trusts has moved at pace, with local NEWS2 champions in place across the country. The partnership approach to this work from NHS England and NHS Improvement’s Patient Safety Collaboratives (PSCs) is a fantastic example of what can be achieved when organisations and teams work closely together to maintain and secure a culture of safety across the system.
In 2018 we also saw the launch of the Suspicion of Sepsis Dashboard, produced in partnership with Imperial College Health Partners through the PSCs and with NHS Improvement. The dashboard is a big advancement in enabling the NHS to accurately measure the number of patients admitted to hospital who are at risk of sepsis. It will also allow the NHS to track improvement, such as rates of survival and length of hospital stays through measuring the number of patients coming into hospital as an emergency with a severe bacterial infection categorized as ‘suspicion of sepsis’.
Since combining the Sepsis and AMR CQUIN to support the Cross System Board’s goal to reduce the impact of serious infections, we’ve seen improvement in the screening and treatment of sepsis, plus a reduction in antibiotic prescriptions.
The rate of screening for sepsis in Emergency Departments has risen from 78% to 91% between 2015 – 2018, and timely antibiotic administration has risen from 63% to 80%. For in-patients with acute deterioration, screening for sepsis has risen from 69% to 86% since 2016 and prompt antibiotic treatment has improved from 69% to 83%. For the first time ever, trusts can now compare their local CQUIN indicator data via Public Health England’s Fingertips website.
We’ve taken time this year to celebrate achievements and good practice by writing to trusts that have performed well against the CQUIN or made the biggest improvements and by publishing case studies to spread best practice.
It’s important to recognise the successes up to now, but we must also maintain our focus on tackling challenges that lie ahead. For example, it’s crucial that safety netting solutions for GPs are improved so patients with an infection (and thought not to have sepsis) are given information and advice on what to look out for and prompted to seek further clinical assessment if they deteriorate.
We must also draw our attention to source control – identifying common presentations of sepsis where there is a focus of infection that requires source control e.g. drainage of an abscess – and developing educational materials to show why it’s important, how it will contribute to improving patient outcomes and furthermore, reduce the risk of antibiotic resistance.
Our focus on patient safety and improving patient outcomes will see a continued effort to embed NEWS2. We will share learning from this work to help understand the role of a standardised early warning score within community settings. Lessons from the NEWS2 programme will also feed into work being led by the Royal College of Paediatric and Child Health to define a single paediatric early warning score (PEWS).
We have undoubtedly made great progress by working collaboratively with partners from across the health and care system. Partnership and collaboration is crucial in tackling sepsis. And through our united commitment we are saving lives. But it’s clear there is more to do.
I welcome this challenge and ask that stakeholders join me in the ambition to truly improve the outcomes of care for people with sepsis.