Recognising sepsis and taking action Dr Michelle Webb Renal Consultant, Associate Medical Director Patient Safety, East Kent Hospitals University NHS Foundation Trust and Co-lead for Sepsis Kent Surrey Sussex Patient Safety Collaborative www.kssahsn.net/safety

Sepsis Sepsis is a life threatening condition that arises when the body’s response to an infection injures its own tissues and organs. It can occur as a consequence of any infection Failure to recognise early and treat agressively can lead to shock, multiple organ failure and death. Sepsis can be caused by a huge variety of different bugs, most cases being caused by common bacteria which we all come into contact with every day without them making us ill. Sometimes, though, the body responds abnormally to these infections, and causes sepsis.

Who is most at risk? The very young and the very old Pregnant women Immunosuppressed Chemotherapy Drug treatments for immune disorders eg rheumatoid arthritis Transplant patients Those with Chronic Diseases eg diabetes

The Facts Incidence UK >100,000 annually 35,000 + deaths per year in UK. More than breast and bowel cancer combined Incidence increased by 8-13% over last decade Third highest cause of mortality in hospital setting Commonest reason for admission to ITU On average 2 children die per day Basic interventions reliably delivered to 80% of patients could save 11,000 lives and £150 million

Delayed Initiation of antimicrobial therapy increases mortality Fig. 3 Delayed Initiation of antimicrobial therapy increases mortality Delayed initiation of antimicrobial therapy increases mortality. Bars represent 95% CI. (From Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34(6):1589–96; with permission.) Crit Care Med 2006;34(6):1589–96

Surviving Sepsis Campaign Aim was to reduce deaths from sepsis by 25% by 2009 Introduced Sepsis Six © 6 elements High flow oxygen Take blood cultures IV antibiotics within 1 hour, “golden hour” IV fluid resuscitation Check lactate Monitor urine output

Evidence that Sepsis Six reduced mortality Fig. 4 Evidence that Sepsis Six reduced mortality Sepsis protocol implementation reduces mortality risk. (Data from Refs. [10,23,81–92].) Source: Critical Care Clinics 2008; 24:1-47

Impact of using Screening Tool - NCEPOD 28% 30% 31% 36% 35% 55%

Impact of Sepsis Six Tool - NCEPOD With care bundle Without care bundle Delay in escalation 9% 26% Delay in administration of administration of antimicrobials 18.5% 38% Fluids delayed/ not received 13% 23% Oxygen delayed / not received 5% 15% Investigation of source of infection 10% 28% Blood cultures not taken 60% 79.5% Less than good documentation of sepsis 19% 33% Blood gases not taken

Why do cases get missed? Infection and Sepsis are a continuum Young people are good at masking signs Early symptoms can be “a flu like illness” or diarrhoea and vomiting Respiratory Rate is the most sensitive early indicator and the least likely to be recorded in the community setting

Relationship between Lactate and Mortality

Purpose of Today To start thinking about how we can: Improve recognition and awareness of sepsis across health and social care Work better together – common tools, common language Improve Safety Netting

Our plan to reduce sepsis incidence and mortality