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District nurse helps community workforce to keep pace with sepsis assessments

Eve Lightfoot wants to ensure community nurses can spot sepsis and deterioration

Eve Lightfoot wants to ensure community nurses can spot sepsis and deterioration

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Picture: SPL

A district nurse has helped to ensure signs of sepsis and other serious conditions are spotted before hospital admission.

Eve Lightfoot of Hywel Dda University Health Board (HDUHB) has fought to address shortages in training and equipment to ensure community nurses can spot deteriorating conditions by carrying out sepsis and National Early Warning Score (NEWS) assessments.

The professional and practice development nurse said: ‘There is a misconception that district nurses only look after leg ulcers and catheters. Our caseloads are complex: we look after patients that would previously have been looked after in hospital.’

Training had lagged behind

The former acute hospital nurse said that when she became a district nursing sister six years ago she realised community nurse training had not kept pace with the conditions being treated.

She was also concerned by the lack of sepsis awareness and the availability of the NEWS and Situation, Background, Assessment, Recommendation (SBAR) tools in the community.

When she initially voiced her concerns, Ms Lightfoot thought people assumed she was struggling to handle her transition from secondary to primary care.

‘I knew this wasn’t the case so I kept knocking on doors and saying there really is a problem here,’ she explained during the Chief Nursing Officer for Wales 2018 Showcase Conference in Cardiff.

Action to tackle sepsis

In 2015, her suspicions were confirmed when the National Confidential Enquiry into Patient Outcome and Death ‘Just Say Sepsis’ report revealed that more than 70% of sepsis starts in the community.

‘With this ammunition I could go back and ask “what are we going to do about it?”.’

She secured a one-day a week research internship at the University of South Wales, Swansea, to look at community nurse knowledge of sepsis and appropriate escalation in the community in Carmarthenshire. She then led a training programme and asked for feedback, with many nurses revealing they did not have the right equipment to carry out assessments.

‘It opened a major can of worms,’ she said. ‘To do a full assessment of NEWS you need to have all the equipment and it became apparent that some people didn’t even have a thermometer, let alone an oxygen saturation probe. 

‘Two years down the line, the probes are there, but it has taken that long for me to get them.’

Annual updates

Ms Lightfoot’s work led her to move into her current role in professional and practice development at HDUHB, and her training will be added to community nurses’ annual updates across the health board’s region of Pembrokeshire, Ceredigion and Carmarthenshire.

She hopes to see intermediate life support training being offered during these updates, as well as the existing basic life support, to recognise the growing complexity of community nurse caseloads.

A GP surgery in Carmarthenshire is also to run a 12-week pilot of NEWS assessments on Ms Lightfoot's insistence, and she hopes more reticent surgeries will follow suit once they see the benefits.

Care home staff development

She plans to improve care home staff’s knowledge to ensure timely and prompt treatment for residents.

Ms Lightfoot said: ‘I wanted to empower district and community nurses to make the right decisions, to have conversations with GPs and families, to make sure we make the right decisions – so very elderly, frail patients are not carted off to A&E at the last moment, and then potentially die in the ambulance or at the A&E doors.’

The nurse also wants to make sure district and community nurses are able to give people recovering from sepsis high-quality care.


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