A series of nurse-led innovations to increase awareness of sepsis at an acute trust have seen the numbers of patients diagnosed and treated for it increase, while the mortality rate has decreased.
As well as training sessions, a range of simple measures were introduced at James Paget University Hospitals NHS Foundation Trust, including stickers for patient notes, resource packs and posters.
“I just thought about ways to make it easier to remember the checks”
Joan Pons Laplana
Transformation nurse Joan Pons Laplana, who joined the Norfolk trust last year, observed a need to ensure diagnoses of “red flag” sepsis were being made and more patients were receiving medication in a “timely manner”.
He said: “I knew that it wasn’t a case of people being unaware of sepsis but we all need prompting sometimes, so I just thought about ways to make it easier to remember the checks.”
As a result, he oversaw the introduction of a programme to remind frontline staff of their duty to look out for signs of sepsis and administer antibiotics, if necessary.
During the first six months, the percentage of inpatients receiving antibiotics within an hour rose from 58% to 71% and the percentage of A&E patients receiving antibiotics within an hour rose from 68% to 80% – mortality increases by 8% for every hour of delay in antibiotic administration.
Meanwhile, the number of reported incidents of sepsis has risen due to better knowledge and sepsis awareness among staff, but the number of patients dying from sepsis has reduced.
From July to December 2016, the trust’s crude mortality rate for sepsis cases fell from 14.5% to 12.1% at a time when it increased both regionally and nationally – from 15.1% to 16.6% and 15.1% to 16.8%, respectively.
In addition, between September and December, the mean length of stay for patients with sepsis fell at the trust from an average of 10.7 days to 7.4 days. The national average for acute trusts remained above 10 during the same period.
“The next step will be to have sepsis champions on every ward”
Joan Pons Laplana
Innovations in the programme involved creating a tool to use in the trust with help from frontline staff, designing a sticker for accident and emergency notes that reminded staff to check for sepsis, running short sepsis awareness sessions that fitted in around shifts, and setting up a sepsis group.
In addition, senior nurses working at night when fewer doctors were around were given the power to administer antibiotics through a Patient Group Directive.
Other measures included putting together a sepsis pack with a step-by step guide that all staff could follow and placing them in designated sepsis drawers and sepsis bags, creating a “sepsis recognition box” at the back of every observation chart and distributing “easy guide” posters across the hospital.
“Our goal was to make it easy for staff to identify sepsis and clear what they should do afterwards,” said Mr Laplana. “For that reason we introduced very simple changes and we avoided new paperwork for clinicians to fill in – in fact we removed some of the paperwork as a result of streamlining the [sepsis] pathway.
“A key success was also creating a pathway where everyone felt involved,” he said. “Everyone has a role to play preventing sepsis. It is paramount to identify sepsis in its early stages and start treatment inside one hour to try to reduce mortality by half and also reduce complications and the impact this has on length of stay.”
Joan Pons Laplana
However, Mr Laplana acknowledged that it was “not possible to change everything at once” and it was important “to focus on one thing at a time”.
“For me, I wanted to ensure that we as a trust are able to deliver the highest quality patient care whilst complying with national guidance and create an easy-to-use tool to help reduce the morbidity and mortality of sepsis within our trust,” he said.
“The next step will be to have sepsis champions on every ward,” he added.
After initial success, a similar staff awareness programme is being rolled out across Queen’s Hospital, which is the main acute site run by Burton Hospitals NHS Foundation Trust.
Compliance for treating those with suspected sepsis within the 60-minute target reached 84% in the last three months of 2016 – up from 60% between April and June, the trust said.
Meanwhile, in February, the country’s first dedicated emergency department-based sepsis team was launched at the University Hospitals of Leicester NHS Trust.
Last month, the National Institute for Health and Care Excellence reinforced the need for nurses and other hospital staff should treat patients with life-threatening sepsis symptoms within one hour.
- Pioneering sepsis training rolled out across hospital
- Country’s first dedicated sepsis team to be based in A&E
- Sepsis must be treated within the hour, says NICE
Measures introduced at James Paget to tackle sepsis
- Contacting Sepsis UK, the Quality, service improvement and redesign (QSIR) network and the Sepsis Forum to maximise opportunities for using the resources already available
- Creating a tool to use in the trust with help from frontline staff
- Designing a sticker for A&E notes, reminding staff to check for sepsis
- Running short sepsis awareness sessions that fitted in around shifts to teach colleagues about sepsis
- Setting up a sepsis group which runs across different wards to encourage shared ownership of treating sepsis
- Empowering the critical care outreach team (CCORT) and the Hospital at Night Practitioners to administer antibiotics by utilising a Patient Group Directive (PGD) – previously only doctors were allowed to prescribe the antibiotics so if the doctor was tied up with another sick patient there may have been delay in administering the antibiotics in a time-sensitive manner
- Putting together a sepsis pack with resources and a step-by step guide that all staff can follow and placing these in designated sepsis drawers and sepsis bags
- Creating a “sepsis recognition box” at the back of every observation chart – re-designing the sepsis pathway (in line with the national guidance through the UK Sepsis Trust) to make it more clear what actions needed completing
- reating visual “easy guide” posters that were distributed across the hospital (for A&E departments and wards)