1. Sepsis Care Bundle- Obstetrics Aneurin Bevan Health Board

2. Number of maternal deaths have decreased but sepsis still remains one of the important causes of maternal mortality in the UK

6. Understanding the Bundle Concept A "bundle" defined as a group of interventions related to a disease process that, when implemented together, result in better outcomes than when implemented individually. The science behind the elements of the bundle is so well-established that their implementation should be considered a generally accepted practice.

7. Severe Sepsis Bundles They are designed to allow teams to follow the timing, sequence, and goals of the individual elements of care, in order to achieve the goal of a 25 percent reduction in mortality from severe sepsis

8. Development of Sepsis care bundle Sepsis tool and severe sepsis care pathway developed based on Health Board guidelines Discussed in Multidisciplinary Joint Anaesthetic meeting and modified Discussed with Microbiologist/Pharmacist for antibiotic guidance Now ready to be implemented on antenatal admission unit and Main Delivery Unit at RGH

12. Temperature 38° C Heart Rate> 90 bpm Respiratory Rate > 20 breaths/min or PaCO 2 < 4.3kPa White Blood Cell Count > 12 or < 4 x10 9 cells/L Does the patient have ≥ 2 of: Does the patient have confirmed or suspected infection? YES SEPSIS CALL FOR HELP! If SBP<90 or evidence of organ under perfusion SEVERE SEPSIS SEPSIS RESUSCITATION BUNDLE – THE FIRST 6HRS Guidelines produced by Dr R Isaacs & Dr D Leslie July 2010 If persistent hypotension (SBP 4 mmol/L CALL ITU (bleep 0133) 1) Measure serum lactate 2) Obtain blood cultures prior to antibiotic administration 3) Administer broad-spectrum antibiotics within 1 hour 4) Treat hypotension and/or elevated lactate with fluids: -deliver an initial minimum of 20ml/kg crystalloid or colloid -administer vasopressors for hypotension not responding to initial fluids to maintain MAP>65mmHg 5) Inform anaesthetist (bleep 0141)

13. 6 hour duties The 6 hour Tool is mainly tool for ITU for anaesthetists This is not modified but will be kept in patients notes along with the screening tool and sepsis pathway.

14. Implementation Evidence-based goals that must be completed within 6 hours for patients with severe sepsis, septic shock For patients with severe sepsis, as many as seven bundle elements must be accomplished within the first 6 hours of presentation. The goal is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis.

15. IMPLEMENTATION Which are the clinical areas for implementation? Who can implement? How can we implement?

16. Areas for implementation Antenatal ward Main Delivery Unit Emergency Gynaecology Unit

17. Who can implement? All involved in patient care

18. How can we implement? Education Pilot Easy availability of documents Laminated guidance on Antenatal admission unit and Main Delivery Unit

19. Contributors Dr A Miskin Mrs L Gokhale, Dr G Smotra Anaesthetist Microbiologist Pharmacist Mrs A Kumar