Implementation of new NHS guidance on sepsis could help improve outcomes and save lives

NHS England issued up to date guidance last month aimed at ameliorating detection and treatment of the disease.

Sepsis is notoriously hard to recognise and it is of particular concern in light of the need for early treatment and high mortality rates, which can be impacted by delays in diagnosis.

What is sepsis?

Sepsis is a serious complication of an infection occurring in any part of the body.  The infection can quickly spread, causing widespread inflammation and interrupting blood flow, leading to damage to tissues and organs.

Sepsis is a particular risk for people who are hospitalised with an illness, patients who have recently had surgery, the very young or very old and those with weakened immune systems.

Symptoms of sepsis include slurred speech or confusion, extreme shivering or muscle pain, passing no urine (in a day), severe breathlessness, skin appearing mottled or discoloured and ‘fits’ or convulsions.

What does the guidance say?

The guidance aims to ensure that patients who are at a high risk of sepsis are swiftly identified. It is a follow up to The National Institute for Health and Care Excellence (NICE) guidance published in 2016, which has been used sporadically, as some staff found it overcomplicated and difficult to put into practice.

Crucially, it is mandatory for trusts to comply with the new NHS guidance, as opposed to merely being encouraged to do so for best practice, as with the NICE guidelines. It is encouraging to see the emergence of stricter guidelines which NHS trusts are obliged to follow in regards to identifying and managing sepsis. There is a contractual requirement for NHS trusts to follow the guidance from April 2019 and failure to meet the guidelines could result in financial penalty.

Key points from the guidance are as follows:

• Wherever possible healthcare staff should aim to suspect sepsis at an early stage and initiate treatment promptly;
• Where there are patients with clinical deterioration due to likely infection or those who are acutely unwell with no clear cause should consider sepsis;
• Physiological variables including temperature, level of consciousness, heart rate and breathing should be measured. Patient history and risk factors must also be considered in conjunction with clinical assessment;
• Importance should be given even to non-specific symptoms and any concerns expressed by family members or carers, such as notable changes in behaviour;
• Even where a diagnosis of sepsis has been discounted for a hospital in-patient, that person should be closely monitored for signs of deterioration and appropriate safety-netting information should be provided. Upon any deterioration, there should be provision for a plan to review and action as necessary;
• Decisions in relation to starting, continuing or escalating life-prolonging treatment for patients suffering from sepsis should be undertaken at Consultant level. If sepsis is suspected and there is no response to treatment within an hour, patients should be seen by or discussed with a consultant urgently.

Why is this guidance needed?

Sepsis kills five people in the UK every hour and many of these deaths are preventable. Sepsis is known as a ‘hidden killer’ as it is an indiscriminate condition which often goes unrecognised by both patients and healthcare professionals. Early diagnosis and treatment is essential to improving outcomes; once sepsis becomes more severe and develops into septic shock the average mortality rate is 40%.

Sepsis has been widely publicised in the press in recent years. Six year old Jack Adcock died in 2011 from a cardiac arrest as a result of sepsis, which staff at Leicester Royal Infirmary failed to recognise. This included Trainee Paediatrician Dr Hadiza Bawa-Garba, who was found guilty of gross negligence manslaughter as a result of the clinical errors she made.

Coroner Maria Voisin also ruled last week that two year old Marcie Tadman lost her life as a result of neglect, after the gross failure of doctors to diagnose sepsis. It was recognised that there were systemic failures on the children’s ward of the Royal United Hospital in Bath. Expert witness Dr Ninis gave her view that if staff had followed their own guidelines and those of NICE, by transferring Marcie to a paediatric intensive care unit, her death would have been avoided.

It is particularly heartening to note that concerns of family members should be taken seriously by healthcare professionals. Patient safety is of paramount importance and, as the guidance is implemented, I hope that the symptoms of sepsis will be recognised at an early stage, appropriate treatment given and ultimately, a needless loss of life avoided.