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SEPSIS MANAGEMENT
Reading the NEWS2 on sepsis management
The UK Sepsis Trust has been running a campaign for several years to encourage first responders and other healthcare staff to ‘Think Sepsis’ when they are assessing a patient initially. Technical editor, Kate Woodhead RGN DMS discusses how effective the campaign has been in England and the current level of awareness.
Sepsis is a common and potentially life- threatening disease triggered by an infection which causes confusion to the body’s immune system. If not treated quickly it can lead to multiple organ failure and death. It claims more lives than lung cancer and is the second biggest killer disease after cardiovascular disease. There are an estimated 123,000 cases of sepsis each year in England and around 37,000 deaths. However, early identification and treatment by healthcare staff can reduce the severe outcomes of disability or death. From April 2019, a change to the NHS standard contract requires all NHS Trusts to comply with guidance on sepsis, written by the Royal College of Physicians, together with many others of multiple specialities.1 NHS England is currently working on developing a paediatric scoring system to mirror the adult National Early Warning Score 2 (NEWS2) system. A Patient Safety Alert was published in April 2018 which asked every acute and ambulance Trust in England to identify a NEWS2 champion to aid the implementation of the revised guidance from the Royal College of Physicians. The Alert reported that the failure to recognise or act on signs that a patient is deteriorating, for example changes in systolic blood pressure or pulse rate, is a key patient safety issue. In 2017, the Alert continues, 100 reports were made to the National
Reporting and Learning System (NRLS) where deterioration may not have been recognised or acted upon and the patient died. Although these patients may not have survived even with prompt action, the care provided did not give them the best possible chance of survival.2
Track and trigger warning systems
The original warning system, NEWS, is a well validated early warning system, used to identify and respond to patients who are at risk not only of sepsis but also of
NEWS2 has been updated to align the measuring system with The Resuscitation Council (UK) sequence ABCDE. The range of boundaries for the physiologicalparameter scores has now been included onto the chart.
OCTOBER 2019
deterioration. It is based on a simple scoring system which collates a score of physiological parameters which are commonly measured at all stages of assessment prior to diagnosis. The six physiological parameters are:
l Respiratory rate l Oxygen saturations l Temperature l Systolic blood pressure l Pulse rate l Level of consciousness.
The Royal College of Physicians recommend that sepsis should be considered in any patient with a NEWS2 score of five or more – ‘think sepsis’. However, NEWS2 should be used alongside clinical judgement as a high score for some individuals ie: those at the end of their life may need to be interpreted differently.
NEWS was originally founded on the premise that early detection, timeliness and competency of the clinical response
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