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Nurses urged to be alert to dangers of sepsis

Nurses need a greater awareness of a life threatening condition which is killing around 37,000 NHS patients each year, Nursing Times has been told ahead of a major report.

The Parliamentary Health Service Ombudsmen is due to publish a report this week exposing widespread failure to adequately recognise and treat patients with sepsis. It will tell the story of 10 patients who died because of preventable failures in their treatment.

The ombudsman, Dame Julie Mellor, will issue a call to action for healthcare professionals to raise awareness of the signs of sepsis and how to treat it, as well as calling for systemic care improvements across the NHS.

Dame Julie told Nursing Times: “We know it is not easy to spot the early signs of sepsis, but if we learn from these complaints and work to improve diagnosis and provide rapid treatment, then lives can be saved.”

The report will be published on Friday to coincide with World Sepsis Day.

Fiona Lawrence, a former intensive care nurse and trustee of the Sepsis UK Trust, noted that education and training on the condition was currently “variable across the country”.

But she said: “Nurses need to familiarise themselves with the signs of sepsis because the earlier we recognise the symptoms the better care these patients will get.”

Sepsis is the body’s response to an infection and can lead to shock, organ failure and death if not recognised and treated quickly. Once it develops there can be as little as six hours to deliver key interventions that can increase survival chances by 20-30%.

Georgina McNamara, a sepsis nurse practitioners at Heart of England Foundation Trust, helped develop the “Sepsis 6”, a list of rapid interventions for suspected sepsis patients (see below).

She said: “Nurses are so under pressure at the moment and we are asking them to have yet another target with sepsis. But, compared with other conditions, it is being left behind and a lot more can be done.”

 

The Sepsis 6 interventions:
1) Give high flow oxygen
2) Take blood cultures
3) Give IV antibiotics
4) Start IV fluid resuscitation
5) Check haemoglobin and lactate
6) Monitor accurate hourly urine output

 

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Readers' comments (21)

  • "...yet another target..."
    The Francis Report highlighted the risks of a target driven culture. Yes we need to measure and evidence practice but at the end of the day, delivering high quality, effective and efficient care is what we aim to and should be delivering.
    Focus on the patient and not the target and the results should speak for themselves.

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  • any one with 2 SIRS should be screened for Sepsis, A simple blood gas quick and easy to check lactate works well at CMFT

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  • This is not before time. My father died because a nurse didn't recognise the signs. Every hospital should independently highlight the potential problems with sepsis on the early warning scoring charts.

    My father would possibly be alive now had this been the case and that is hard to deal with.

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  • if patients are being observed and looked after properly there is no need for early warning charts or any other bits of nonsense. they are probably more of a cause for missing the signs than saving lives. there is nothing which replaces skilled care and fast responsive action where it is needed if you are to prevent tragedy!

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  • Robert McEwen | 10-Sep-2013 9:59 am


    if everybody is so busy focussing on their targets what happens to all the gaps in between which may not be targeted and thus missed completely. therein lies the danger one might say! lets see a move back from management to nursing care.

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  • Anonymous | 10-Sep-2013 1:14 pm

    if patients are being observed and looked after properly there is no need for early warning charts or any other bits of nonsense. they are probably more of a cause for missing the signs than saving lives. there is nothing which replaces skilled care and fast responsive action where it is needed if you are to prevent tragedy!

    I have been a bit sceptical of EWS charts and as you say always relied on my own skills of observation as well. But, you cant really argue with the EWS system particularly if there are some staff who aren't experienced. Id rather be asked to check a patient or ask a Doctor to check a patient rather than have that patient deteriorate.

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  • michael stone

    Just an observation - this piece, I think, is about sepsis not being spotted in time, and it ends with a list of interventions for sepsis, which seems to me to be treatment for sepsis which has already been spotted: wouldn't a list of the signs and symptoms which might indicate that sepsis is devloping, fit (the article) rather better ?

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  • michael stone | 10-Sep-2013 3:11 pm

    perhaps you should go and study what sepsis is and its nursing and medical diagnosis and treatment before you start passing judgement on how it should be managed and how the article should have been written.

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  • surely the first 'intervention' is to summon help and make sure the doctor comes to see the patient, without that none of the other interventions can happen.

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  • This is why the EWS is a useful tool in alerting the nurse to a potential change in a patients condition and ensuring closer monitoring.

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  • Anonymous | 10-Sep-2013 8:29 pm

    our first interventions on a general medical ward were always vital signs, call the doctor take blood for the first pair of haemocultures at half hourly intervals if core temeprature over 38C and insert a venflon if there was not already an intravenous line then follow doctor's orders for the rest.

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  • A low temperature can also be an indicator in sepsis, obviously not everybody with a low temp will have sepsis. A SIRS alert and screening criteria on the observation charts should mean that potential cases are picked up and treated at an early stage.

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  • Two of the following could indicate sepsis:
    Temperature > 38 or 12
    Resp rate > 20
    Heart rate > 90
    (SIRS criteria)

    SIRS could be due to infection but other causes exist.

    Is there a focus of infection?

    Lactate > 2, raised INR, reduced urine output, hypotension 40 mm Hg are indicators for severe sepsis as they indicate organ failure onset.

    In the first hour after recognition of sepsis:
    Antibiotics
    Fluids
    Oxygen
    Catheterise for hourly urine measurement

    Cultures if temperature > 38.

    In my ED we have a pro-forma for the management of sepsis, intended for the medics, but useful for nursing staff as a guide particularly when deciding the triage category.

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  • michael stone

    Anonymous | 10-Sep-2013 5:08 pm

    Thank you, follower, but you missed my point, as usual. What I'm saying is that as this article is about

    'The Parliamentary Health Service Ombudsmen is due to publish a report this week exposing widespread failure to adequately recognise and treat patients with sepsis'

    then the information provided by the several anonymous posters preceeding this post, about when developing sepsis should be suspected, should probably have been in there, instead of just listing behaviour after sepsis was already suspected.

    With all of these dire warnings about a lack of new antibiotics in the pipeline and developing resistance, sepsis could become a bigger problem in the future.

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  • So do we really have "nurses " working in acute care environments whose skills do not extend to recognising patients with a possible sepsis?

    According to the latest NT "survey" many cannot also not recognise a patient who may be a risk of an acute renal injury !

    If all this is true the Daily Fail have it right!

    NHS "nurses" really are a disgraceful wast of space !







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  • Anonymous | 12-Sep-2013 10:05 am

    So do we really have "nurses " working in acute care environments whose skills do not extend to recognising patients with a possible sepsis?



    Sadly yes we do, and doctors as well. This is not just about recognising sepsis it is about not acting on abnormal observations or not even doing regular observations of a sick patient in the first place.

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  • When and how does the profession start to learn? This is from over 7 years ago.

    http://www.nursingtimes.net/sepsis-death-rates-unacceptable/472536.article

    Probably too much time is spent on ticking the wrong boxes.

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  • So many targets.......not enough arrows......

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  • Anonymous | 12-Sep-2013 10:05 am


    NHS "nurses" really are a disgraceful wast of space !

    Yes. Why don't we believe everything we read and fire all those disgraceful individuals who you think are a waste of space? Let's not spend any time acknowledging the phenomenal effort put in daily by the vast majority of well trained, hard working and caring nurses for crap remuneration. You'll miss us when we're gone.

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  • Anonymous | 13-Sep-2013 3:14 pm

    aren't some comments just best ignored? such attempts at destructive criticism have no value and one has no idea who they are coming from and why. you know the work you do has the greatest value and is appreciated by very many. please keep up the good work.

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