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Pressure grows for action on sepsis


Identifying and treating sepsis could soon be given the same attention as reducing pressure ulcers and hospital acquired infections, Nursing Times has learned, as a campaign to tackle the potentially fatal condition heads to parliament.

Chief executive of the UK Sepsis Trust Ron Daniels was due to make the case for action to an influential committee of MPs on Tuesday.

He is calling for hospitals to be given a financial incentive to focus on spotting sepsis early, in a similar way to the drive to assess all patients for risk of venous thromboembolism. This has been credited with a significant reduction in blood clots among inpatients.

Senior critical care nurses have backed the move while NHS England medical director Sir Bruce Keogh is understood to support of the idea.

Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. It can lead to shock, multiple organ failure and death, especially if it is not recognised early and treated promptly.

It is estimated to kill 37,000 people in the UK every year – more than breast, lung and bowel cancer combined. Academics have calculated that at least 11,000 of these lives could be saved if basic good practice around sepsis care was followed.

Dr Daniels told Nursing Times the “horrific number of deaths from hospital-acquired infections pales into insignificance compared with the number of sepsis deaths”.

He is calling for hospitals to be incentivised to screen patients who present with symptoms compatible with infection or abnormal physiology for sepsis.

They could receive a commissioning for quality and innovation payment (CQUIN) if they achieved a certain level. These payments have been used to incentivise a reduction in healthcare acquired infections and pressure ulcers.

Dr Daniels, a consultant in critical care and anaesthesia, was due to address MPs on the Public Administration Select Committee on Tuesday and was also due to meet with NHS England next month to discuss this and other ideas.

“Sir Bruce Keogh is supportive in principle. However, the commissioning framework for next year is unclear,” he said.

Rachel Binks, a member of an Intensive Care Society steering group and a nurse consultant working in critical care at Airedale Foundation Trust, backed calls for a financial incentive for trusts.

She said: “If we had a CQUIN and trusts had to make sure they did the right thing or they wouldn’t get the money, from my point of view, as a nurse, that would be really helpful because it would mean we would all have a responsibility financially and clinically to do the right thing.”

If spotted promptly, sepsis can be treated with antibiotics. However, its symptoms are difficult to spot and patients can deteriorate quickly.

Many organisations already use the Sepsis 6 bundle when a patient is suspected of having sepsis. The bundle was developed by the UK Sepsis Trust and championed by NHS England last week in a patient safety alert (see page 4). It sets out six actions to be taken within the first hour of suspected sepsis, which can double a patient’s chance of survival.

However, in many cases sepsis is not identified or even considered until it is too late.

Lesley Durham, executive member of the National Outreach Forum, told Nursing Times that the NHS hierarchy could often delay prompt action even when sepsis had been spotted early.

“There are a lot of links in the chain that can delay treatment starting,” she said, She said an extra incentive would be “fabulous” – although major problems with how sepsis is currently recorded would make it difficult to measure performance.

Karin Gerber, a member of the British Association of Critical Care Nurses’ board and an outreach nurse at the Royal Berkshire Foundation Trust, said a financial incentive such as CQUIN would help focus everybody in an organisation on addressing the problem, not just nursing staff.

“We can put in as much training and teaching as you like but, if you don’t get the blood cultures to the labs in a timely fashion or there is no one there to take the blood test, then the window of opportunity is lost,” she said.

Ms Gerber told Nursing Times that sepsis should be one of the first things a nurse or healthcare assistant should think about if a patient’s early warning score was rising and that they should also consider it if an elderly patient suddenly became more confused or had a fall.

She also said that more needed to be done to raise awareness of sepsis among GPs, paramedics and community staff.

A spokesperson at NHS England said: “NHS England is currently developing proposals for incentive schemes for commissioners and providers for 2015-16 and will publish details later in the year.”

Early identification and treatment of sepsis


Readers' comments (5)

  • Community health staff should definitely have a similar focus on sepsis to those working in hospital environments. Many elderly patients and those with long term conditions are susceptible to infection from sores and ulcers, with sepsis a very real risk.

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  • This initiative is long overdue and something I have felt very strongly about for many years. Systems and processes also need to be looked at in terms of not only identifying when a patient is very unwell and clearly developing sepsis, but in making sure they receive the prescribed antibiotics as a matter of urgency. Too often this in not seen as a priority and doctors and nurses can seem lackadaisical in their approach, not appreciating their lack of immediate action can lead to an unnecessary and preventable death. I am aware of patients who have waited up to 12 hours for urgent IV antibiotics. This is not acceptable under any circumstances. This is an initiative I wholly support and am delighted to see it being put at the top of the agenda.......

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    The sight of bare bones revealed through the flesh is truly shocking

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  • Successful treatment for pressure sores has a long way to go to become reliable, especially for severely disabled patients even when in a hospice.

    Just putting sepsis on the same path guarantees very little except publicity.
    The sight of bare bones revealed through the flesh is truly shocking

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