NICE sepsis guidelines
Sepsis is a rare but serious reaction to an infection and it can be a life threatening condition. It is believed that each year 65000 people in the UK survive sepsis (some with long term disabilities from the illness) and a further 37000 people die from it. It is identified as the leading cause of avoidable death in the UK, killing more people than breast, bowel and prostate cancer combined.
It is therefore welcome that in July 2016 NICE published Sepsis: recognition, diagnosis and early management guidelines (NG51). The Guideline Development Group first met in July 2014, and consisted of thirteen members, who were healthcare professionals with a particular interest in sepsis (GP, Paediatricians, ICU and Emergency Care Consultants, Paramedic etc), and two lay members representing the patient and carer perspective. Over a two year period the group carefully assessed all the evidence (provided by systematic reviews on topics representative of the scope of this guideline), and made their recommendations for the future care of sepsis patients.
Catherine White, ICUsteps Trustee and former sepsis patient, was one of the members of the panel:
Those of us who have experienced sepsis, either as a patient, relative or as a clinician, know what a devastating condition this is, and how important that consistent, high quality care is provided. This is a very challenging illness, not least in the varied symptoms that it can begin with (which can make the initial diagnosis very difficult) and the speed of which it can progress to become life threatening. Over 70% of patients with sepsis become ill in the community, and may seek help from a variety of healthcare professionals (pharmacists, GPs, nurses, ambulance staff etc), who even though they might not see sepsis that often, must be able to identify it and act quickly. I know from my own critical illness how subtle the early signs of sepsis are, and how easily patients and medical staff can underestimate the need for prompt treatment – yet it is at this crucial time, when every hour can make the difference between surviving sepsis or not.
In developing this guideline, we had many robust discussions about what recommendations were needed, but also what was practical to implement! But the resulting guideline is not a compromise, because we did not shy away from making the tough decisions. Of particular interest, are the recommendations around the timing of antibiotic treatment (within an hour of sepsis recognition for people who are most ill) and the importance of senior clinical review. The guideline also stresses that the concerns of patients, relatives and carers must be listened to when initially assessing for sepsis. It is sometimes their observations of subtle changes in behaviour that is an important indicator that sepsis should be suspected.
I believe this guideline will make a real difference… but this is only the beginning of transforming the treatment of sepsis. The key message from the guideline is for healthcare professionals to think ‘Could this be sepsis?’ and for the public to think ‘Is this sepsis?’ – and it is that collective awareness that is our biggest weapon against this condition.
You can read the recommendations and full guidelines on the NICE website.