Time is Life in Sepsis! Are scores and numbers all we worry about? The Emergency Floor Sepsis Team.

Emergency Floor Sepsis Project Time is life SCREEN & TREAT EF SEPSIS PROJECT Screen major patients Risk stratify with red flags Antibiotics in severe sepsis < 1 hour

RCEM Audit 2013-2014 Only a median of 32% of patients received antibiotics within 1 hour across all Trusts.

The EF screening tool Use of clinical acumen alongside EWS and SIRS when screening for sepsis Risk stratification with 9 red flags (the 9 easily and quickly available in the EF)

The Sepsis Project May 2015: Sepsis team working on the screening tool. June 2015: Screen tool incorporated in the Cas Card Nurses and Doctors using the tool on every Major and Resus patient Sepsis teaching, shop floor teaching, dedicated resource on the desktop (SPACE). Sepsis super heroes (SSH) championing the project on the shop floor Signposting on drug cupboards Monthly Audit and face to face feedback Presentation of cases to Governance meetings and breakfast meetings Leaflets, posters in the EF

Audit June/July 2015 50% of patients with severe sepsis/red flag sepsis received Abx < 1 hour September 2015 75% patients had Abx < 1 hour (21/28) Median time to Abx: 49.5 min

Audit Problems Solutions Delay in identification of septic patients Delay in Abx administration Solutions Need to identify patients ASAP Escalate early Allocate a nurse in charge to giving IV Abx More nurses trained for IV

Lessons learnt Delays in identification of septic patients are multifactorial The exit block and flow problems have a huge impact Shortage of senior nurses Importance of working as a team Data capture Importance of monthly Audit and face to face feedback

Severe sepsis Is there an infection? ONE or more red flags? TIME IS LIFE IN SEPSIS! Systolic BP<90 mmHg ABG Lactate >2 mmol/L HR >130/min RR>25/min New reduced GCS pO2<8kPa SpO2<91% Oliguria Creatinine>177 (new) Antibiotic <1hour Fluid resuscitation Monitor Escalate to Senior Doctor

Early identification of septic patients Any temperature /rigors? On chemotherapy (within 4 weeks)? Generally unwell? Any infection? Escalate immediately to the Consultant/Registrar in charge

In summary… In 6 months, the treatment of patients with severe sepsis has massively improved, without any extra resource (money or HR). Early identification and early escalation to a senior clinician is essential When sepsis is identified, risk stratification with red flags needs to be immediately performed. The possible source of infection should be sought and documented. The use of a care bundle is encouraged by the RCEM and NCEPOD recommendation