Wessex PSC is working with organisations across Wessex to reduce harm related to sepsis.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
It is a condition that can lead to shock, multiple organ failure and death if it is not recognised early and treated promptly. Each year in the England, over 1.2 million people are admitted with bacterial infection with 86,000 deaths. The numbers that are actually admitted and die from sepsis are not known, but are estimated at around 100,000 and 40,000 respectively.
Patient Safety Measurement Unit and Suspicion of Sepsis Dashboard
The Patient Safety Measurement Unit (PSMU) supports the delivery and success of our national patient safety improvement programmes, such as the Patient Safety Collaborative.
The PSMU Suspicion of Sepsis (SOS) Insights Dashboard is an innovative, dynamic and intuitive tool that clinicians and other stakeholders can use to promote the effectiveness of quality improvement interventions for infections that could lead to sepsis. It is a breakthrough tool for positive messaging to improvement teams.
The SOS Dashboard has been created by Imperial College Health Partners (ICHP) through the Patient Safety Collaborative (PSC), in Collaboration with NHS Improvement and NHS England. It builds on the methodology for measuring sepsis previously published by Oxford Academic Health Science Network (AHSN).
Using this multi-user, web-enabled and interactive dashboard, improvers can visualise the impact of interventions and tell a story about their improvement journey. It is also a handy tool for engagement with system partners to share best practice and learning.
The SOS-Insights Dashboard is designed as an open resource for all and an NHS login is not required to use it.
Think sepsis: a film for all healthcare workers involved in the care of sick children
This awareness-raising teaching video from Health Education England has been developed to help health care professionals spot and respond to the warning signs of sepsis in children.
Sepsis Guidance (including use of NEWS2) in Primary Care
Sepsis: Guidance for GPs" (RCGP 2018) notes a culture shift from accepting that sepsis is often hard to detect, to one where it is actively being assessed whenever infection is being considered as a cause for significant illness or deterioration.
The use of NEWS isn’t advocated as a replacement for clinical judgement, but physiological assessment must be undertaken when considering sepsis and/or the deteriorating patient. The RCGP note that NEWS offers a template for doing this and may be considered as a potential adjunct to the assessment process and it also offers a useful shared language for communicating concern between clinical services and clinicians.
The full document can be downloaded from the resources zone on the right hand side of this page.
Sepsis and Deterioration
Wessex PSC chose Sepsis as one of it's topics for the 2015/16 Sepsis Collaborative following which a pan-Wessex Sepsis Network was created to provide ongoing support to staff working to improve the delivery of high quality and safe sepsis care to patients across Wessex.
Initially focussing on the management of Sepsis Wessex PSC has now expanded it's remit to cover all aspects of the recognition and rescue of patients with physical deterioration including the use of NEWS.The latest information about Wessex PSCs work on deterioration can be found on our Deterioration web page.
Wessex AHSN have also shared a number of Sepsis related videos covering a variety of healthcare settings including Hospitals, Primary Care and Ambulances, as well as a patient's story. These can be viewed on the AHSN Sepsis Video webpage.
Sepsis Training Resources
Sepsis is a rare but serious complication of an infection. Without quick treatment, sepsis can lead to multiple organ failure and death.
If sepsis is detected early and hasn't yet affected vital organs, it may be possible to treat the infection at home with antibiotics. Most people who have sepsis detected at this stage make a full recovery.
Almost all people with severe sepsis and septic shock require admission to hospital. Some people may require admission to an intensive care unit (ICU). Because of problems with vital organs, people with severe sepsis are likely to be very ill and the condition can be fatal.
However, sepsis is treatable if it is identified and treated quickly, and in most cases leads to a full recovery with no lasting problems.
The Health Innovation Network (HIN) has been working in partnership with NHS England and the ASK SNIFF Safety Netting Collaborative to produce 'Spotting the signs of sepsis in under 5s'.
The film, featuring NHS paediatrician and TV presenter Dr Ranj Singh, has been designed to raise awareness of sepsis amongst parents of children under 5, as well as to standardise the information clinicians provide for parents of children with fever well enough to be cared for at home.
'Spotting the signs of sepsis in under 5s' is available on this page and on NHS Choices, where full details of current NHS sepsis advice can be found. Digital information packs to accompany the film are available to Emergency Department clinicians and also for clinicians in primary care.
If you'd like more information about the HIN/NHS England sepsis project, please visit the Health Innovation Network website.
Early recognition and treatment of sepsis is key to improving outcomes. Treatment guidelines have been produced by the Surviving Sepsis Campaign and remain the most widely accepted standards. Current best practice is based upon evidence for care bundles in sepsis.
One bundle dealing with basic therapies, the ‘Sepsis Six’, has been shown to improve outcomes in septic patients. If the 6 factors are completed within the first hour following recognition of sepsis, the associated mortality has been reported to reduce by as much as 50%. The 6 factors are:
Sepsis: recognition, diagnosis and early management (NICE guideline NG51 - July 2016)
This guideline covers the recognition, diagnosis and early management of sepsis for all populations. The guideline committee identified that the key issues to be included were: recognition and early assessment, diagnostic and prognostic value of blood markers for sepsis, initial treatment, escalating care, identifying the source of infection, early monitoring, information and support for patients and carers, and training and education.
Full details of the NICE NG51 guideline and an interactive flowchart can be found on the NICE website.
Sepsis: A simple, pragmatic, evidence based approach to detection, collaboration and measurement (Dr Matt Inada Kim)
A webinar based course from Dr Matt Inada Kim from the Wessex Patient Safety Collaborative including up to date information about sepsis, quality improvement tips and tricks, and new guidelines for a more collaborative care pathway can be accessed here.
Produced by Matt Inada-Kim, Acute Physician Hampshire Hospitals, National Clinical Advisor, Clinical Lead for Physical Deterioration and Sepsis, Wessex PSC, and Relias Learning.
Wessex PSC worked with improvement teams from healthcare organisations across Wessex to make changes to improve the delivery of care for patients with Sepsis. Wessex PSC provided support to these teams via methods including structured learning events, Faculty provided subject matter expertise, Improvement coaching support, webinars and site visits. Senior executives and managers from participating organisations were also involved to provide local leadership and commitment.
Wessex organisations involved with the 2015/16 Sepsis BTS included:
One of the outputs from this BTS Collaborative was a short film aimed at raising awareness about Sepsis entitled "Sing a Song of Sepsis". The film clip, featured on the right hand side of this page, was funded by the Wessex Patient Safety Support Fund which aims to support Wessex based projects focused on improving patient safety.
More information about the work of the Fund can be found on our Patient Safety Support Fund web page.
An Outturn report demonstrating the impact of this Collaborative on patient care and staff capability across Wessex can be downloaded from the resource zone on the right hand side of this webpage.
Following the successful completion of the 2015/16 Sepsis Collaborative a pan-Wessex Sepsis Network was created to provide ongoing support to staff working to improve the delivery of high quality and safe sepsis care to patients across Wessex. Initially focussing on the management of Sepsis the network expanded in 2017 to cover all aspects of the recognition and rescue of patients with physical deterioration including the use of NEWS.
More information about Wessex PSCs work on deterioration can be found on our Physical Deterioration web page.
The Network is co-ordinated by Geoff Cooper who is the Programme Lead and Improvement Coach for the Wessex PSC Sepsis Workstream.
The Clinical Lead for the Network is Dr Matt Inada-Kim who is a consultant acute physician at Hampshire Hospitals NHS FT, NHS(E) National Clinical Advisor on sepsis, co-chair of the National AHSN sepsis cluster, Lead for sepsis and deterioration at Wessex PSC and attends the NHS Cross System Sepsis Programme Board.
The Wessex Sepsis Alliance is a sub-group of the Sepsis Network and consists of West Hampshire CCG, GPs, Care Homes, South Central Ambulance Service, Hampshire Hospitals NHS Foundation Trust and the Wessex Patient Safety Collaborative working in partnership.
The alliance draws together sepsis projects across separate organisations to join up care across the patient journey. To improve our recognition and response to sepsis the current work is around the use of the National Early Warning Score [NEWS] across all care sectors. The Patient Safety Collaborative has a focus on connecting and sharing across Wessex to improve patient safety; this includes the spread and adoption of best practice.
Wessex PSC is supported by NHS England to ensure that local and regional learning is shared nationally. As a member of the national Sepsis Cluster, Wessex is working with other AHSNs to ensure that the lessons learned about sepsis care are shared across the NHS.
Standardising the language of deterioration in healthcare (Wessex PSC - May 2017)Dr Matt Inada-Kim and Geoff Cooper (Wessex SC) presented at the National Patient Safety Collaborative Learning Event at the Emirates Stadium on 23 May 2017 on the subject of Standardising the language of deterioration in healthcare.
The presentation was delivered in conjunction with Mr Andrew Brent (Oxford AHSN) who presented the Oxford Sepsis Pathway measuring patient outcomes using an approach based on a "Suspicion of Sepsis".
The slides from this session can be downloaded from the resource zone on the right hand side of this web page.
Defining and measuring suspicion of sepsis: an analysis of routine data (BMJ Open June 2017)
The objective of the paper was to define the target population of patients who have suspicion of sepsis (SOS) and to provide a basis for assessing the burden of SOS, and the evaluation of sepsis guidelines and improvement programmes.
The full paper can be downloaded from the resource zone on the right hand side of this web page.
World Sepsis Day 13 September 2017
The World Sepsis Day held in 2017 saw the publication of two documents by NHS England.
This document describes an operational definition of sepsis and supports the implementation of the NICE guidelines on the identification and treatment of sepsis.
This document contains a summary of the key actions that health and care organisations across the country will take to improve identification and treatment of sepsis.
RCGP Consensus Report (2017)
Consensus Report produced by the 2017 RCGP Sepsis Summit which defines the elements of an integrated sepsis aware community and healthcare system, and outlines how various stakeholders can contribute to this.
This report can be downloaded from the resource zone on the right hand side of this web page.
As with all our work the Sepsis workstream is underpinned by the principles of co-design and co-production – that is to say that we place the patient/carer at the heart of what we do. We want to ensure that users' own experiences help shape our work.
To achieve this we use the ARISE+ model (Aims, Recruit, Integrate, Support & Evaluate) which outlines a practical approach to co-production. It has been designed (with improver feedback) to support the integration of patient and carer representatives within Quality Improvement projects.
Developed by the Wessex Patient Safety Collaborative the ARISE+ model helps individuals, teams and organisations to start conversations around effective co-production.
More information about Wessex PSCs work on co-production can be found on our Working with our patients and public web page.
A copy of the ARISE+ model can be downloaded from the resources area on the right hand side of this page.
NHS England (NHSE) published a “Sepsis Action Plan” in 2015 and in April 2016 issued "a rallying call to healthcare professionals across the country to focus on improving the early recognition and timely treatment of sepsis.
NHSE have also produced a free audit tool that GPs can use to assess their performance in managing febrile illness in children:
NICE published guidance in 2016 to help healthcare professionals diagnose sepsis. A Quality Standard on sepsis is due for publication in summer in 2017.
Health Education England (HEE) published a report in 2016 ‘Getting it right: the current state of sepsis education and training for healthcare staff across England’ which includes a summary of the work undertaken in response to gaps in education and training. (The Report and the Executive Summary can be downloaded from the resources section on this page.)
HEE's E Learning for Healthcare site have produced an e-learning package “Think Sepsis: the identification and management of sepsis in primary care”.
Sepsis logo created by, and used with permission of, The Royal Bournemouth & Christchurch Hospitals NHS FT.
If you have any questions about the Sepsis workstream, or any other aspects of the Wessex Patient Safety Collaborative, please contact us via the link below.