Risk Tips for Early Detection and Management of Sepsis

PMP’s article Beware Sepsis -Think Sepsis discusses the prevalence, cost and “red flags” for early diagnosis of this potentially life threatening illness. According to the UK Sepsis Trust, every year in the UK, there are at least 200,000 episodes of sepsis, with up to 52,000 people dying as a result. A missed or delayed diagnosis can have tragic consequences, and even patients who survive sepsis often suffer long-term physical, psychological, and cognitive disabilities.

Risk management strategies

Clinicians can implement various risk management strategies to increase understanding around sepsis and promote early recognition and action. For comprehensive guidance, please refer to The Sepsis Manual 4^th edition 2017 – 2018 by the UK Sepsis Trust. Examples of these strategies include the following:

1. Provide education and training for all staff on the early detection and management of sepsis. This should include education on the use of the National Early Warning Score (NEWS) and the UK Sepsis Trust, Sepsis Screening and Action tools.

2. Ensure all clinical staff are aware of the common infections associated with sepsis, such as urinary tract infections, pneumonia, abdominal infections, skin/soft tissue infections and postpartum endometriosis. If investigating or treating maternal sepsis, clinicians should be aware of recent advice from the Royal College of Obstetricians and Gynaecologists, as stated in a BMJ article November 2021: “viral infections must routinely be considered as a possible cause of postpartum infection”.

3. Highlight to all staff the patient population groups at increased risk for sepsis, such as:

• Infants (under one year of age) and older people (over 75 years of age).
• Patients who have had trauma, surgery or other invasive procedures in the past six weeks.
• Patients on chemotherapy.
• Patients who are immunocompromised due to a co-morbid condition (such as diabetes mellitus, HIV, cirrhosis, sickle cell disease, or asplenia).
• People with any breach of skin integrity (for example, cuts, burns, blisters or skin infections).
• Women who are pregnant, are post-partum or have had a termination of pregnancy or miscarriage in the past six weeks.

NB: this is not a comprehensive list and the National Institute for Health and Care Excellence (NICE) provides further information.

4. Be aware of atypical symptoms in high-risk patients, such as general malaise, agitation or behavioural change. Patients with sepsis may not always present with a high temperature. Indeed, some present with hypothermia.

5. Following a confirmed diagnosis or suspicion of sepsis, institute an action plan as a matter of urgency. Consider using the Sepsis Six care bundle (as outlined below). The application of this management plan has been shown to reduce the relative risk of death by 46.6 percent when delivered to patients with severe sepsis within one hour.

1. Administer high flow oxygen
2. Take blood cultures and consider infective sources
3. Administer intravenous antibiotics
4. Give intravenous fluid
5. Check lactate levels
6. Commence hourly urine output measurement.

6. Ensure appropriate antibiotic use, guided by the suspected focus of infection, in line with local/national prescribing guidelines. Follow evidence-based guidance on the use of antibiotics tailored to cover the likely pathogens. If in doubt, discuss with the microbiology or infectious diseases team. Review the choice of antibiotic after culture and sensitivity results are reported.

7. Depending on the patient’s condition and your competency to safely manage sepsis, you may need to collaborate with other members of the multi-disciplinary team for a specialist opinion.

8. Ensure that you keep accurate and clear notes in the patient’s medical records, including all negative and positive findings.

9. Managing a patient with sepsis can be a stressful experience for all those involved in their care. It is important that the lead clinician provides effective leadership and keeps staff up-to-date with the patient’s care plan and any changes in their condition or treatment. Make sure adequate communication channels are in place, including robust handover procedures, so that staff can update colleagues regarding the condition of the patient and relay any concerns.

10. Maintain open and honest communication with patients and their families throughout this challenging episode of care.

As sepsis continues to have a significant impact on patient outcomes and the resilience and wellbeing of clinicians, it is vital to raise awareness of the condition. The existence of the appropriate knowledge, tools and protocols to manage sepsis cases will enable clinicians to increase early identification and timely management of the condition. Utimately, this may help save lives and reduce the costly burden on the healthcare system.

If you are a PMP policyholder and are involved in a patient safety incident or receive a complaint from a patient call the PMP medicolegal helpline as soon as possible in line with your policy terms and conditions. You can access the helpline directly from the PMP web app or via the number on your policy documents.