Sepsis Six 1. Administer oxygen to maintain oxygen saturations > 92% 2. Take blood cultures and other samples 3. Give broad-spectrum antibiotics according to local policy 4. Give intravenous fluid challenges 5. Measure serum lactate, and repeat if initially elevated 6. Measure accurate hourly urine output


a 30 per cent risk of death so nothing should be leſt to chance. Start the clock ticking following presentation: it is not acceptable


to start the clock ticking on first identifying red flag sepsis; rather it should be when having first identified the condition. For emergency departments and acute medical units, this might be at triage, but for inpatient facilities we should acknowledge that even in acute trusts, guidelines mandate observations only every 12 hours in otherwise stable patients.


Implications for increased awareness For 2016/17 and into the next financial year, NHS England has (via commissioners) put in place a national lever to drive improvement in hospitals, requiring that they screen for sepsis and deliver antimicrobials promptly. Te Royal College of General Practitioners has developed a sepsis toolkit, NHS England has issued a Safety Alert, and Health Education England has developed a suite of resources. Tese all aim to increase the awareness of the condition and its treatment. With increasing levels of public awareness, and following the


Parliamentary and Health Service Ombudsman’s report of 2013, complaints around sepsis are on the rise. Guidelines will give way to a NICE Quality Standard in 2017, which will make deviation from accepted protocol harder to defend. It is crucial that healthcare professionals can show that


reasonable steps were taken to identify sepsis, and to assess and investigate the symptoms. Organisations are expected to demonstrate that systems are in place to facilitate recognition and intervention. Of course, not every situation in which diagnosis or treatment


to listen to the patient and their relatives: health professionals will ignore phrases like “I’ve never seen him this ill” or “I feel like I’m going to die” at their peril. NICE, the UK Sepsis Trust and the international Surviving


Sepsis Campaign all recommend the delivery of a set of basic care elements for patients within the first hour – in the UK and in other countries these are described by the Trust’s ‘Sepsis Six’ care bundle. Te Sepsis Six (see box) is a set of interventions which can be


delivered by any junior healthcare professional working as part of a team – all it requires is a qualified prescriber and basic healthcare equipment. Executing these six steps in the first hour following presentation with sepsis will double the patient’s chance of survival. A majority of patients will begin to improve rapidly once the


Sepsis Six are delivered in a timely fashion. For those who don’t, or who continue to deteriorate, early contact with seniors and with critical care is of paramount importance: patients with sepsis have


WINTER 2016


was delayed will amount to negligence. Healthcare professionals must have exhibited unreasonable and inappropriate actions (or inactions) – for example not investigating symptoms or leaving the patient without basic care (e.g. fluids or antibiotics). Clear medical records that explain an individual’s actions and the steps they took to dismiss or confirm any suspected diagnosis, together with clear documentation of intervention, are important. It can be difficult to link negligence to causation of harm in a


condition as deadly and complex as sepsis where deterioration may be rapid, but early intervention is beneficial. Once septic shock has developed, there is only a 50 per cent chance of survival. For every hour that life-saving antimicrobials are delayed in septic shock, the risk of death increases by almost 8 per cent. In summary, following the NICE guidelines, which have been


operationalised in the UK, will provide key protection – and these include recognising red flag sepsis early and delivering the Sepsis Six within one hour, communicating and escalating clearly and keeping clear records of those actions in the medical records.


n Dr Ron Daniels BEM is chief executive of the UK Sepsis Trust and a global sepsis expert


17


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24