Nurses working in the community urged to look out for signs of sepsis
New NICE guidance urges professionals working across all healthcare settings, including primary and community care, to treat people with life-threatening sepsis in one hour.
National Institute for Health and Care Excellence (NICE) draft guidance urges professionals working across all healthcare settings, including primary and community care, to treat people with life-threatening sepsis in one hour.
The guidance stresses that patients should be assessed carefully and when they are classed as high risk, they should be reviewed and treated immediately.
The new draft guidance draws out recommendations from NICE’s 2016 guidance. It states that health professionals in any setting should check people with suspected sepsis for specific signs that determine whether their symptoms are life-threatening. This includes recording vital signs such as temperature and heart rate, as well as checking for rashes and skin discolouration.
Number of people affected by sepsis every year in the UK
Anyone identified as high risk should be reviewed immediately and given antibiotics and intravenous fluid treatment within one hour. The guidance adds that if it will take more than an hour to get a patient to hospital, antibiotics can be given in general practice.
'Severe symptoms can develop in sepsis very quickly,' says NICE deputy chief executive Professor Gillian Leng. 'If high-risk patients are not identified and treated promptly, people can be left with debilitating problems. In worse cases, they may die.'
Professor Leng says that the quality standard 'highlights priorities in the continued fight to improve sepsis care'. She adds: 'We know from recent case reviews that there are inconsistencies in how people’s symptoms are assessed in different settings. More can be done to provide rapid treatment.'
Adult deaths, annually in the UK
Sepsis is caused when the body’s immune system overreacts to infection and attacks its own organs and tissues. It is an unpredictable condition that can strike at any time. It affects people of all ages. When sepsis is identified and treated quickly, patients are more likely to make a full recovery. If it is not identified and treated quickly, it can rapidly lead to organ failure and potential death. Sepsis leaves thousands of survivors with life-changing disabilities.
In February, an independent study commissioned by UK Sepsis Trust found that sepsis is costing the UK economy up to £15.6 billion a year.
NICE and UK Sepsis Trust have devised a number of screening tools for healthcare professionals working across all settings. The community nursing screening and action tool can be applied to all non-pregnant adults and young people aged 12 years and over.
'The community screening tool starts by asking if you are worried the patient is sick – such as if they appear unusually drowsy,' says UK Sepsis Trust executive lead nurse for education, Georgina McNamara. Ms McNamara also works as a critical care outreach nurse. She was one of the first sepsis nurse practitioners in the UK.
'For nurses working in the community, it can be more difficult as they do not have all the facilities at their fingertips that secondary care has. For example, they may not be able to carry out a full set of observations in the community. However, they know their patients well and that can make it easier to identify when something is wrong.'
Red flag symptoms include increased heart rate, low blood pressure reading, increased respiratory rate plus high temperature or low temperature. Another important observation is urine output, particularly if a patient has not passed urine for 12-18 hours. Blood pressure is measured as a first line of enquiry in children. Presenting features for children may include feeling abnormally cold to touch, looking mottled or blue with very pale skin, having a rash that does not fade with pressure, raised respiratory rate and being lethargic and difficult to wake up.
'Additional questions for assessing children include ascertaining whether they are or have been vomiting, whether they have had any fits or convulsions which may be related to their temperature and whether they are off their food,' says Ms McNamara.
In terms of children who have been off their food for 24-48 hours, Ms McNamara adds: 'It is a question of whether it is a new onset symptom and whether the child presents with any other red flag symptoms which indicate a high risk of sepsis. If that is the case, dial 999 as the patient needs to immediately go to hospital. Treatment within that first hour is key.'
Lives could be saved through earlier diagnosis
Listening to the concerns of parents who feel their child is unwell or carers and families who are worried about the health of a vulnerable loved one is one area where there is room for improvement across all settings, says Ms McNamara. 'We must start listening to people better than we currently do. Sometimes as medical professionals, we feel it is all in our observations but sepsis does not discriminate. It can affect anyone.'
UK Sepsis Trust perspective – 'It’s essential that we take adult sepsis seriously'
A 2016 public health campaign to empower parents to recognise sepsis symptoms in their children is leading to improved outcomes, says The UK Sepsis Trust. The charity is hoping to launch a public health awareness campaign on sepsis in adults next. Adults make up 90% of the 250,000 annual cases of sepsis in the UK. They also account for 98% of the 44,000 annual deaths caused by sepsis.
'Last year, we launched a crucial awareness campaign to empower parents to recognise sepsis symptoms in their children,' says UK Sepsis Trust chief executive, Ron Daniels.
'The posters and leaflets distributed across the UK are improving outcomes for the 25,000 children affected by the condition every year. But sepsis also claims 43,000 adults lives annually – that’s 98% of all sepsis deaths in the UK. It’s essential we take adult sepsis seriously and increase public recognition of the key symptoms,' Dr Daniels adds.
Community nurse insight – 'The relationship that nurses have with their patients is invaluable'
'Nurses working in primary and community care settings interact with patients and families from across the lifespan and it is therefore essential they are mindful of the signs and symptoms of sepsis,' says RCN’s professional lead for primary and community care Kathryn Yates.
'They can play an important role in raising awareness of sepsis not only with their patients and clients, but also with allied and social care colleagues that the nurses may work with across primary, community and social care. Seeking out opportunities to be more proactive and preventive, including raising awareness of sepsis with patients and carers, is an important part of our roles.
'If you think about the campaigns around meningitis, sepsis also needs a similar awareness-raising profile. The relationship nurses have with their patients is invaluable. However, it is important to offer relevant information on sepsis to patients, carers and families at a level they can understand and engage with.
'This may include talking about what they could do if they were worried about themselves or another person or if they felt unwell or were concerned that they might be at risk.'
NICE and UK Sepsis Trust’s community nursing sepsis screening and action tool