Before we introduced the Lead Nurse for Deteriorating Patient and Sepsis, we looked at our quality
account for 16/17 which identified that we needed to do something differently.
We know that sepsis kills 44,000 people within the UK every year and the unwarranted variation
that we found was that in September 2017 there was only a 17% compliance with the Sepsis
Screening Tool. We put a Quality Improvement team together, which incorporated a multi-disciplinary
team approach to sepsis so that we were all coming at it from the same angle. We introduced
a nursing integration leadership programme where nurses are feeling empowered to be able
to escalate patients that may have sepsis. We rolled out the sepsis training to all of
the people regardless of their role because receptionists have a role to play, porters
have a role to play, registered nurses do. We introduced physios and occupational therapists
into a multi-disciplinary approach along with our doctors. Our physios are really key in
that aspect and they themselves have identified a patient who has deteriorated with sepsis.
We attended the training and the next day, myself and one of my colleagues were going
to see a patient and they just didn’t seem right, so we checked all the observations
and things and their NEW (National Early Warning) score was quite high so then we felt confident
enough to say to the nurses and the doctors this patient has suddenly deteriorated and
we think it might be sepsis. Infected cut on the hand, do you think that’s
quite common? I think we all think we know about deteriorating
patients and the signs of sepsis but it was a real eye opener and the impact it has on
patients’ lives. For me personally, the escalation process was really, really important
and which doctors to escalate to, to ensure that patients got the quickest medical treatment
and the right medical treatment. My role as a Sepsis Champion is really important. It
allows a link between the Sepsis Lead Nurse and the ward. I help educate the staff on
the ward, teach them how to use the pro-formas correctly, help identify and support them
in treating patients that have been identified as having sepsis.
If the patient comes in by ambulance, the paramedics will hand over that a patient maybe
has several red flags. They’re querying whether the patient maybe has sepsis or not.
What we then tend to do is make sure we screen that patient for sepsis.
The observations we do using the early warning scoring system will indicate a score and if
that score is 5 or more or 3 and 1 parameter we then know that this could be sepsis and
we activate the sepsis screening tool. This is a really easy to use piece of paper and
it identifies red flags. When it’s activated that this could be sepsis, the Sepsis 6 is
on the back of the tool and it tells us what to do and it’s basically 6 interventions
that need to occur in the first hour to achieve the best possible outcomes for the patient.
I think the best outcome that we’re really proud to have achieved is the completion of
our sepsis screening tool. In 8 months we’ve measured that we’ve improved from 17% compliance
to 96%. Michael, he had been unwell for a number of
months with various health conditions, so when Michael presented at the emergency department
he was screened for sepsis within the first 15 minutes of his arriving, he had a set of
observations completed. Those observations revealed a National Early Warning score of
6 which means that Michael clearly had some elements of organ dysfunction.
Christmas 2017 I myself was ill over New Year with the flu. Since then I wasn’t feeling
right. I never really paid it much attention. When somebody presents at the emergency department
and they have got multiple comorbidities or they’ve got a complex past medical history
like Michael had, what tends to happen is those patients can sometimes be missed, because
sepsis has a lot of symptoms that can be related to other conditions.
The outcomes have been really powerful so we’re above 90% for our ED screening, we
are currently at 89% for our IV antibiotics within 1 hour in the emergency department
and we’ve managed to get our sepsis screening and treatment for inpatients to 100% for the
last 5 months. In Leading Change, Adding Value, I really
think that we’ve demonstrated commitment 8 within the department