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

2. 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

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

4. 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)

5. 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

6. 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

12. 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

13. 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

14. 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

15. 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

16. 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