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Sepsis must be treated within the hour, says NICE

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Nurses and other hospital staff should treat patients with life-threatening sepsis symptoms within one hour, according to the National Institute for Health and Care Excellence.

In a new draft quality standard, NICE has urged that patients should be assessed carefully for sepsis and when someone is classed as high-risk, they should be reviewed and treated within an hour.

“This quality standard highlights priorities in the continued fight to improve sepsis care”

Gillian Leng

The quality standard, published today for consultation and backed by the health secretary, draws out recommendations from NICE’s 2016 guideline on the condition.

It states that clinicians in any setting, but specifically accident and emergency departments or GP practices, should check patients presenting with suspected sepsis for specific signs that determine whether their symptoms are life-threatening.

Healthcare professionals – such as GPs, paramedics and healthcare professionals working in emergency departments – should use a structured set of observations to stratify risk in people with suspected sepsis, according to the NICE standard.

Every patient with suspected sepsis should be examined for mottled or ashen appearance, cyanosis of the skin or mouth, non-blanching rash of the skin, any breach of skin integrity and any rash indicating potential infection.

They should also have their temperature, heart rate, respiratory rate, level of consciousness and oxygen saturation assessed.

“This advice shows how vital it is for clinicians to treat life-threatening symptoms as soon as possible”

Jeremy Hunt

In addition, NICE noted that children under 12 years with suspected sepsis should have capillary refill assessed.

Meanwhile, blood pressure should be measured in adults and young people over 12 years, in children aged five to 11 years if facilities – including a cuff of correct size – are available, in children under five years if heart rate or capillary refill time are abnormal and if facilities are available.

Any patient subsequently identified as high-risk should be reviewed immediately by senior hospital staff, and should get antibiotics and intravenous fluid treatment within one hour.

If it will take more than an hour to get to hospital, antibiotics can be given in GP practices or by ambulance staff, noted NICE.

Leng_Gillian2_co.jpg

Gillian Leng

It cited a 2015 report by the National Confidential Enquiry into Patient Outcome and Death that highlighted that 40% of people admitted to A&E with sepsis did not have a timely review by a senior clinician.

NCEPOD’s Just say Sepsis! report also said there were avoidable delays in administering antibiotics in 29% of cases and inconsistencies in early use of IV fluid.

In addition, the NICE quality standard states that people who are classed as being low-risk should be given information on what to do if they continue to feel unwell and how to get further medical help.

NICE deputy chief executive Professor Gillian Leng said: “Severe symptoms can develop in sepsis very quickly. If high-risk patients are not identified and treated promptly, people can be left with debilitating problems. In the worst cases, they may die.

“This quality standard highlights priorities in the continued fight to improve sepsis care,” stated Professor Leng.

“We know from recent case reviews that there are inconsistencies in how people’s symptoms are assessed in different settings,” she said. “More can be done to provide rapid treatment.”

Jeremy Hunt

Jeremy Hunt

Jeremy Hunt

Commenting on the new NICE quality standard, health secretary Jeremy Hunt said: “Every death from sepsis is a tragedy, yet too often the warning signs are missed.

“We need to get far better at spotting sepsis across the NHS and this advice shows how vital it is for clinicians to treat life-threatening symptoms as soon as possible,” said the health secretary.

Mr Hunt added that a million leaflets and posters had already been distributed to GP clinics, hospitals and other public places to help raise awareness to “fight against this devastating condition.”

The health service ombudsman, Dame Julie Mellor, also welcomed the development of the institute’s new quality standard.

“We are pleased NICE has produced this guidance following our recommendation to ensure faster diagnosis and treatment of sepsis, ultimately saving thousands of lives,” she said.

julie mellor

julie mellor

Julie Mellor

“We have seen too many cases of families who have lost their loved ones to this condition due to delays and missed warning signs,” she noted.

Dame Julie highlighted the ombudsman’s 2013 clinical report, Time to Act, which focused on its casework of patients with severe sepsis who did not receive the treatment they urgently needed.

It recommended that NICE should prepare a quality standard for the management of severe sepsis.

The draft NICE quality standard is now out for public consultation until Friday 7 April 2017. The final quality standard is expected to publish in August.

NICE quality statements for sepsis

  • Statement 1 – People with suspected sepsis are assessed to stratify risk of severe illness or death using a structured set of observations.
  • Statement 2 – People with suspected sepsis in acute hospital settings and at least one criteria indicating high risk of severe illness or death are reviewed by a senior clinical decision-maker within one hour of risk being identified.
  • Statement 3 – People with suspected sepsis in acute hospital settings and at least one criteria indicating high risk of severe illness or death have antibiotic treatment within one hour of risk being identified.
  • Statement 4 – People with suspected sepsis in acute hospital settings, at least one criteria indicating high risk of severe illness or death, and with lactate over 2mmol/litre, have an intravenous fluid bolus within one hour of risk being identified.
  • Statement 5 – People who have been seen by a healthcare professional and assessed as at low risk of sepsis are given information about symptoms to monitor and how to access medical care.
  • 2 Comments

Readers' comments (2)

  • Should we be thanking Jeremy Hunt for his reminder on timely treatment? I would pull him in for some urgent clinical supervision and attempt to get him to reflect deeply on why assessment and treatment times are really such an issue. I really can't bare to read anymore of his smug and inane comments!)

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  • Laura Hodgetts

    The NHS are actually getting better at recognising sepsis and routinely using the red flag/ fabulos framework (which is again due to chance) and initiated the 6in 60 for treatment of sepsis. Isn't this is further due to change in the next 12 months anyway (based on further guidance) as well as te addition of screening for sepsis on the MEWS/NEWS chart

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