Nurses and doctors are to take part in a sepsis screening pilot at a trust in Nottingham from this month, which will ensure every patient is automatically assessed for the disease when their vital signs are recorded electronically.
Those behind the pilot at Nottingham University Hospitals NHS Trust said it was hoped the new system would help to address gaps in “every stage of the process” for identifying and treating sepsis quickly.
“In the past, we know people have taken observations and for whatever reason have not realised or noticed the patient has deteriorated”
The trust stopped using paper records and moved over to only using electronic devices for observations and handovers in 2015.
As part of the switch, all nurses, junior doctors and healthcare assistants each have a mobile device to carry out their work.
Under the pilot, once these “e-observations” are recorded by the device, it will now also automatically process this information to screen for sepsis.
The device will use an early warning score system based on recently updated sepsis criteria from the National Institute of Health and Care Excellence.
If the patient is at high risk, the device will then alert the nurse who took the observation and also send a second alert asking the nurse if the patient meets the physiological criteria for sepsis and whether the believe they have an infection.
“This tool is trying to get away from the enormous range of human factors present in paper-based observations and screening”
If the nurse believes that is the case then a message is sent out to both the nurse in charge of the ward, as well as the doctors responsible for the patient, prompting them to carry out an assessment within an hour.
At the same time a reminder is sent to the nurse who took the observations that they should implement sepsis guidelines.
The pilot will begin for two weeks at the end of January in the trust’s acute medicine unit, and is expected to be quickly rolled out to all of the organisation’s adult wards by the end of March – of around 60 – before also being used at its children’s hospital in April. By that point, around 6,000 nurses and doctors will be using the new system.
Those behind the pilot said it was hoped the system would reduce manual errors in sepsis screening and treatment, such as wrongly recorded observations or delays in alerting members of staff, and lead to fewer patients dying from the condition.
“Sepsis is a big killer and over the last 10 years there has been a lot of focus to ensure we have clinical systems in place to identify patients, because there is something you can do about it,” said Mark Simmonds, deputy divisional director for medicine and sepsis clinical lead at the trust.
“In the past, we know people have taken observations and for whatever reason have not realised or noticed the patient has deteriorated and failed to rescue a patient who has severe sepsis,” he told Nursing Times.
“What we are doing at Nottingham is at the forefront of mobile healthcare”
“What this tool is trying to do is getting away from the enormous range of human factors present in paper-based observations and screening, and really acting as a decision support tool for clinicians both at the bedside and remotely,” he added.
He said the trust had analysed data going back to 2005 that showed cases where patients had abnormal observations for “many hours” but no-one further was alerted, leading to patients dying.
“Although in our protocol the nurse in charge and our critical care outreach team and doctors should be informed about high early warning scores and abnormal observations, we all know that manual based protocols are not always adhered to,” said Dr Simmonds.
“So through very detailed case analysis we’ve been doing here for 10 years with sepsis patients we knew that there were gaps at every stage of the process – whether it was taking the observations on time, writing the score down correctly or communicating the score out,” he added.
Nottingham University Hospitals NHS Trust
Dr Simmonds noted that phoning other members of the clinical team to alert them about a patient with sepsis could take up to 25 minutes, and “when you’ve only got one hour to give those antibiotics that’s a lot of time”.
He told Nursing Times that the use of mobile devices by the trust’s clinical staff was “revolutionary” for instant communication.
However, he acknowledged that the NHS more widely had so far “failed to really grasp” mobile technology. “What we are doing at Nottingham is at the forefront of mobile healthcare,” he said.