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Georgina McNamara: We need more specialist nurses to drive improvement on sepsis

Despite some progress, the initial treatment for many patients diagnosed with sepsis is still too slow. Getting it right could save 14,000 lives a year, says Georgina McNamara from the UK Sepsis Trust

Despite some progress, the initial treatment for many patients diagnosed with sepsis is still too slow. Getting it right could save 14,000 lives a year, says Georgina McNamara from the UK Sepsis Trust

Sepsis continues to kill more people than breast, bowel and prostate cancer combined. Current figures from the national coding system suggest that more than 250,000 people are affected every year in the UK, with around 44,000 deaths. Of those affected each year 10,000 are children.

We cant be sure exactly how many deaths there are because causes of death are recorded using definite and probable sepsis codes. A registry that captures the actual

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Despite some progress, the initial treatment for many patients diagnosed with sepsis is still too slow. Getting it right could save 14,000 lives a year, says Georgina McNamara from the UK Sepsis Trust


A child being examined at the Royal Aberdeen Children’s Hospital, where senior staff
nurse Drew McDonald developed a tool to help nurses identify sepsis. He
won the Child Health category of the 2017 RCNi Nurse Awards.
Picture: Newsline

Sepsis continues to kill more people than breast, bowel and prostate cancer combined. Current figures from the national coding system suggest that more than 250,000 people are affected every year in the UK, with around 44,000 deaths. Of those affected each year 10,000 are children.

We can’t be sure exactly how many deaths there are because causes of death are recorded using ‘definite’ and ‘probable’ sepsis codes. A registry that captures the actual figures is certainly needed.

There are also difficulties in the assessment of global incidence. We know, however, that sepsis is a huge killer. Indeed, according to the World Health Organization it now kills as many people as tobacco.

Savings through compliance

A study commissioned by the UK Sepsis Trust and carried out by the independent York Health Economics Consortium has found that increasing compliance with the NICE guideline on sepsis by 10%, 20% or 30% would deliver annual direct NHS savings of £83 million, £166 million and £249 million respectively.

We know that the main sources of sepsis continue to be pneumonia (50% of cases), urinary tract infections (28%), abdominal infections (11%) and skin and soft tissue infections (9%). We also know that for each one-hour delay in the administration of antibiotics to patients who have septic shock mortality increases by 7.6%.

NICE’s recommendations, made in July 2016 and updated in September 2017, changed how sepsis is classified, with ‘SIRS’ (systemic inflammatory response system) and ‘severe sepsis’ replaced with ‘infection’, ‘sepsis’ and ‘septic shock’.


A micrograph showing bacteria among red blood cells. Harmful bacteria in the
bloodstream result in bacterial sepsis. Picture: Science Photo Library

There have also been some subtle changes to the sepsis six protocol for tests and treatment, which now include the administration of oxygen to maintain saturations above 94%, rather than the previous recommendation of high-flow oxygen. The UK Sepsis Trust has introduced ‘red flags’ for sepsis, which clinical staff can use at the bedside, resulting in prompt delivery of the sepsis six.

We have since seen an increase in antibiotic consumption in emergency departments and acute trusts, but it is not clear how much this can be attributed to improved compliance.

New measures to improve identification

Public Heath England is set to deliver safety netting cards for paediatrics, which has come as a direct result of health and social care secretary Jeremy Hunt admitting that the NHS is ‘totally inadequate’ at spotting sepsis. Mr Hunt announced new measures last year to improve sepsis identification, tracking and prevention.

While we are starting to make improvements in the recognition and treatment of patients with sepsis, we still have varied communication that requires local education and training at ward level as well as in our EDs. This means we need strong and effective multidisciplinary leadership at all levels.

A 2015 report by the charity NCEPOD (National Confidential Enquiry into Patient Outcome and Death), looking at all healthcare providers, found that the reason for delay in treatment of patients with sepsis in 59.5% of cases was because healthcare professionals failed to ask for specialist help.

Sepsis nurses the next step

If we got treatment right at the front door to health services, and at ward level, then we estimate we could save around 14,000 lives a year in the UK. The message about sepsis is being heard, but the initial treatment still needs to be quicker for those with an absolute diagnosis.

Progress remains patchy. We have sepsis nurses in some hospitals, but this is not a recognised specialist role in many areas despite the high number of deaths associated with sepsis.

Specialist nurses are in place to treat patients affected by other conditions with high mortality figures. If we are going to build on the progress of recent years then the sepsis nurse should be an essential role.


Georgina McNamara is lead nurse for education, UK Sepsis Trust

 

 

Resources 

Read a selection of our most popular sepsis articles here 

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