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What emergency nurses should do when assessing sepsis risk in people with learning disabilities

A deteriorating patient with a learning disability can present with the most common triggers for sepsis and it is often up to emergency nurses to recognise them

A deteriorating patient with a learning disability can present with the most common triggers for sepsis and it is often up to emergency nurses to recognise them

Picture shows a scene from a video featuring a song called Check Me for Sepsis, performed by the Purple All Stars, a group of people with learning disabilities who use the creative arts to convey health promotion messages.
A scene from the video Check me for sepsis performed by the Purple All Stars

Emergency nurses are accustomed to rapid identification and treatment of life-threatening medical emergencies, such as acute coronary syndrome and acute exacerbation of chronic obstructive airways disease.

But these conditions are not the major causes of death among people with a learning disability.

Pneumonia, aspiration pneumonia and sepsis are the biggest causes of death in this population, who are more likely to die at a younger age than the general population.

People with a learning disability who are at greater risk

People with a learning disability who require support with eating, drinking and swallowing are at greater risk of hospital admission and death from respiratory infection.

They are also five times more likely to be admitted to hospital with a lower respiratory tract infection or a urine infection than people without a learning disability.

These infections are the most common triggers for sepsis.

The Learning Disabilities Mortality Review found sepsis was more likely to be the cause of death when there were gaps in a patient’s care which had contributed to their death, suggesting a failure to recognise or treat sepsis.

Everyone with an infection is at risk of developing sepsis, so it is important that people with a learning disability, and those who care for them, know what sepsis is, how to recognise the early signs and understand the importance of seeking urgent medical attention.

We can empower people with a learning disability to take care of their own health by presenting health messages in understandable and memorable ways.

The song Check me for sepsis, developed as a collaboration in Hertfordshire to raise awareness of sepsis among people with a learning disability, is a catchy tune with a serious message. It is performed by the Purple All Stars, a group of people with learning disabilities who use the creative arts to convey health promotion messages.

Check me for sepsis video helps raise awareness

The video gives instructions to seek help when people feel unwell due to an infection and gives them the vocabulary to ask appropriate questions.

Watch the video

Sepsis is a medical emergency and should be considered a potential diagnosis whenever assessing a deteriorating patient with a learning disability.

Nurses have a statutory responsibility to make reasonable adjustments to the care given to patients with a learning disability to ensure they receive equitable healthcare.

This may be as simple as spending more time exploring what brought them to the emergency department (ED) or using adjuncts to facilitate prompt treatment.

Using an ultrasound device to ensure successful first-time intravenous cannulation may take a little longer to organise, but may be a less distressing experience for the patient.

The early signs of sepsis, such as flu-like symptoms, new confusion and gastro-intestinal  disturbance, may be more difficult to interpret in someone who communicates differently.

Always include the carer in an assessment for sepsis

Joint aches may manifest as distress when being touched or moved, new confusion may present as a change in attention span or coordination, and gastro-intestinal disturbance may present as high output from a percutaneous endoscopic gastrostomy or other enteral feeding tube.

Assessment of urine output is a challenge if the person uses incontinence pads, but not beyond the ability of most EDs.

Weighing incontinence pads on arrival and at regular intervals may reassure or indicate a need for catheterisation to accurately monitor fluid balance.

The absence of fever does not rule out infection.

If the person has a carer, always include the carer in the assessment, looking for their interpretation of what is usual for this person and what has changed to bring them to the ED.

Beware of making assumptions: without irrefutable evidence that the patient’s baseline includes altered vital signs, there should be full escalation and response to all abnormal observations.

Infections and sepsis are major causes of acute physical deterioration and death in people with a learning disability.

In the words of the song and on behalf of all patients with a learning disability: ‘Check me for sepsis, that’s all I ask.’

Sepsis resource collection

Anne Hunt is sepsis lead nurse at East and North Hertfordshire NHS Trust; and Kate Harding is a creative practitioner at Hertfordshire Health Liaison Team

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