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Sepsis diagnosis: overworked nurses fail to assess patients within an hour – study

Sepsis Six protocol training should be mandatory for all nurses, says lead author 

Sepsis Six protocol training should be mandatory for all nurses, says study’s lead author

Being overworked and understaffed are the top two reasons nurses fail to assess patients for sepsis within an hour, a new study suggests.

The research, published in the British Journal of Nursing , is based on questionnaires completed by 98 ward-based nurses at an NHS teaching hospital in Wales.

Short staffing can lead to early signs of

Sepsis Six protocol training should be mandatory for all nurses, says study’s lead author

Sepis lead nurse Carrie Hayhurst demonstrates good practice by preparing an antibiotic IV infusion to patient Susan Elizabeth Corby at Leicester Royal Infirmary.
Sepis lead nurse Carrie Hayhurst demonstrates good practice by preparing an antibiotic IV infusion to patient Susan Elizabeth Corby at Leicester Royal Infirmary. Picture: Tim George

Being overworked and understaffed are the top two reasons nurses fail to assess patients for sepsis within an hour, a new study suggests.

The research, published in the British Journal of Nursing, is based on questionnaires completed by 98 ward-based nurses at an NHS teaching hospital in Wales.

Short staffing can lead to early signs of sepsis being missed

Respondents reported that heavy workloads and short staffing were the most frequent barriers to completing the Sepsis Six protocol, a tool to guide swift identification and treatment for sepsis.

‘Due to looking after a lot of patients at one time, there is a risk of not noticing the early signs of patient becoming septic,’ one nurse respondent wrote.

Lack of skills among agency staff cited for sepsis delays

Others highlighted issues caused by an over-reliance on agency staff, including delays reporting abnormal symptoms in patients, and a lack of skills such as venepuncture and cannulation.

‘Short staffing levels, high acuity levels on the ward, delay in getting bloods and cannulation due to not having the skills,’ another nurse wrote.

What is sepsis?

Sepsis is the immune system’s overreaction to an infection or injury, for reasons not fully understood.

It has relatively vague symptoms that can be mistaken for other conditions.

In adults, these include:

  • Acting confused
  • Slurred speech or not making sense
  • Blue, pale or blotchy skin, lips or tongue
  • A non-blanching rash
  • Difficulty breathing, breathlessness or breathing fast

Sepsis kills around 48,000 people a year in the UK, according to the UK Sepsis Trust.

The study, which set out to explore the effect of sepsis training, found 72 out of the 98 nurses (73%) had received training, while 26 (27%) had not.

Call for mandatory sepsis training for nurses in all healthcare settings

Those who had training were more likely to have screened patients for sepsis, with 90% (65) of the trained nurses having done so compared with 58% (15) of the non-trained nurses.

Lead author and advanced nurse practitioner Eirian Edwards argued that sepsis training should be mandatory for all nurses in all settings.

‘Before COVID-19, sepsis was one of the biggest killers out there,’ she told Nursing Standard. ‘If we can identify these patients early on the wards, we could prevent them developing severe sepsis and going into septic shock.’

Awareness of sepsis must improve on general wards, says study’s lead author

Ms Edwards added that while awareness of sepsis was common in emergency departments, it was important that nurses in other areas of the hospital were also able to recognise and act on warning signs.

‘There’s a lot of things going on in terms of recognising sepsis at the front door of the hospital,’ Ms Edwards said. ‘But not so much on the general wards where patients tend to deteriorate quietly without being picked up.’


Find out more

British Journal of Nursing (2021) Sepsis Knowledge, Skills and Attitudes Among Ward-based Nurses


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