Findings of the NCEPOD report Just Say Sepsis!
The much anticipated findings of the NCEPOD Sepsis report were published on 24th November, 2015. Sepsis occurs when the body is overwhelmed by an infection and it is believed that there could be 200 000 cases in the UK each year. It is also the leading cause of avoidable death in this country, killing more people than breast, bowel and prostate cancer combined. Sepsis can progress very quickly, and it is vital that patients receive timely and appropriate medical care.
Catherine White, a former sepsis patient and ICUsteps trustee, was the patient representative on the panel that oversaw this study. She said:
I know firsthand what a devastating illness sepsis can be. I was pleased to be involved with this study, which took a real life snapshot of the quality of the treatment for sepsis across the country. In May 2015, NCEPOD reviewed the case notes of 551 adult patients from 305 hospitals throughout the UK and their findings have formed the basis of this report. I hope these findings will further focus minds to ensure that all patients receive the care they need, no matter where in the UK they live. Too many families have lost loved ones, and anything to prevent this, must be done.
Overall the investigators found some good practice throughout the country, but there were definite themes for areas for improvement. These include:
- 45% of the patients included in the study who were admitted to hospital with no other obvious functional problems, either suffered from a disabling condition at discharge or died with sepsis.
- One third of hospitals in the study had no formal sepsis protocol.
- Of hospitals with a sepsis protocol, there was no formal training on general wards in the use of the protocol for medical staff in 21% and nursing staff in 27%.
- No early warning scores (EWS) system was used in any of the GP notes reviewed and in only 27% of secondary care notes. In secondary care where EWS/ screening tool was used there were fewer delays in diagnosis of severe sepsis.
- There was poor adherence by GPs in recording vital signs: only 26% of patients had their temperature taken and 31% of patients had their heart rate taken.
- In the emergency department there was also inconsistency in recording vital signs. Only 41% of patients had a complete set of vital signs recorded.
- 20% (116/571) patients in the study were not reviewed by a consultant within 14 hours of admission.
- Only one third of patients (135/434; 31%) were documented as being started on a sepsis care bundle following diagnosis. Management on a care bundle was associated with fewer delays in the treatment of patients with sepsis.
- All hospitals should have a formal protocol for the early identification and immediate management of patients with sepsis. The protocol should be easily available to all clinical staff, who should be trained in its use.
- Primary and secondary care clinicians should use an early warning score (EWS) for patients to prioritise urgency of care where sepsis is suspected, such as the National Early Warning Score (NEWS) to aid recognition of severity of sepsis.
- Patients should have a full set of vital signs taken on arrival in the emergency department in line with the Royal College of Emergency Medicine standards for sepsis and septic shock.
- In line with previous NCEPOD, and other national report recommendations on recognising and caring for acutely deteriorating patients, hospitals should ensure the necessary staffing and resources to:
- review all acutely ill patients by a consultant within the recommended national maximum of 14 hours after admission
- make formal arrangements for patient handover
- access critical care facilities where patient care has to be escalated
- provide a 24/7 critical care outreach service (or equivalent) in hospitals with critical care.
- Trusts/health boards should aim to reach 100% compliance with the implementation of a care bundle as part of the care pathway for all patients diagnosed with sepsis.