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The Chief Executive of the UK Sepsis Trust talks about improving patient outcomes through collaboration and how a united commitment across professions is the best way to tackle the life-threatening disease that kills 37,000 people annually:
This year, just 12 months after the adoption of a Resolution on Sepsis, The World Health Organisation (WHO) chose to feature sepsis in their annual ‘Clean Your Hands’ campaign.
The WHO advised health professionals around the world; ‘It’s in your hands to prevent sepsis’.
We health professionals do indeed have it ‘in our hands’ to prevent some cases of sepsis – not only through hand hygiene, but also through examining every aspect of our infection prevention practice. We can identify and educate high risk patients, and play our part in encouraging public uptake of appropriate vaccinations.
However, with 75% of cases of sepsis arising in the community, and with the sheer scale of the problem, we have to do much more.
Sepsis affects at least 200,000 people in England every year, claiming more than 37,000 lives.
As Founder and Chief Executive of the UK Sepsis Trust (UKST), but above all as a front-line clinician facing patients with sepsis, I’ve been working hand-in-hand with NHS England, specifically with Celia Ingham Clark, Medical Director for Clinical Effectiveness, and the Cross System Programme Board, to reduce the horrific burden of this disease. We are making progress.
Around 72% of trusts contribute data to the national CQUIN on sepsis and over the last two years the reliability of screening eligible patients for sepsis, for example, those with a high National Early Warning Score (NEWS), has risen from 50% to 87%. The rate of urgent administration of antibiotics to those who need them has risen from 50% to 80%.
So we are making astonishing progress, but variability persists.
This journey, which since 2015 has been one of collaboration between UKST, the Royal Colleges, regulatory bodies and others, has demanded that we overcome challenges united in order to put in place systems to tackle one of our nation’s biggest killers. The one problem we haven’t faced is resistance: the professions are united in their commitment to fix sepsis.
For me, what has stood out on this journey is pragmatism. We’ve had both new international guidelines and a new international definition in the last two years. As well as the recognition that we need operational tools to help deliver care more rapidly and communicate our message into communities. This progress has been incredibly refreshing
In 2016, NICE released clinical guideline NG51 around the recognition and management of sepsis. The prompts which this document used to empower health professionals to treat sepsis were broadly accepted, but a lack of evidence limited NICE’s ability to identify useful ‘screening prompts’ other than clinical or carer concern.
The problem this presents is that, in hospitals at least, the identification of deterioration begins with the ‘eyes and ears’ of the acute sector – our health care assistants (HCAs), whose primary role is to observe and monitor rather than diagnose.
This year the Royal College of Physicians has released the second version of the National Early Warning Score – or NEWS2. The opportunity that we’ve all seen with this is one of transformational change. Though the first version had established itself in some organisations, others showed little motivation to move away from their local variations.
If we’re going to fix sepsis – one of our most prevalent causes of deterioration and death – we need a common language which empowers our HCAs and others. NEWS-2 provides just that.
A subgroup of the Cross System Programme Board sets out to establish a position statement to be undersigned by the colleges, NHS England, NICE and the UK Sepsis Trust. In this statement organisations are asked to encourage their staff to ‘think sepsis’ in any patient triggering an aggregate NEWS-2 of 5 or higher, as well as in any patient with risk factors or for whom clinical concern exists. This allows organisations to empower such staff to initiate an immediate review by a decision-maker, placing them well on the path to reliable response to deterioration.
NEWS-2 is now increasingly being adopted by ambulance services, care homes, and in general practice. With this ground swell of acceptance, we are heading ever closer to a common language for deterioration.
We have already saved many hundreds of lives from sepsis in England in 3 short years. Now, we have it in our hands to save thousands more.