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News and Updates from todays Sepsis Summit: Ensuring Adherence to the National Quality Standard

Sepsis – the silent killer and leading cause of deterioration
Dr Ron Daniels
, Chair, The UK Sepsis Trust, Consultant in Intensive Care, Good Hope Hospitals NHS Foundation Trust
Dr Ron Daniels BEM is a Consultant in Critical Care at Heart of England NHS Foundation Trust, Birmingham, England. He’s a Fellow of the Royal College of Physicians of Edinburgh, Royal College of Anaesthetists and Faculty of Intensive Care Medicine. Ron is Chief Executive of the Global Sepsis Alliance, having been instrumental in bringing World Sepsis Day and the Chairman’s concept of the World Sepsis Declaration to fruition. In May 2017, following unanimous approval of the Executive Board of the World Health Organisation, he was part of an Executive Board successful in securing the adoption of a resolution on sepsis by the 70th World Health Assembly.

This morning Ron talks about the scale of sepsis as a cause of death and the difficulties in recording sepsis cases – its undercounted significantly because it’s often the underlying cause of death, likely to capture only 40% of episodes because of the way NHS currently captures data.
‘Might be’ sepsis codes which captures data more realistically starts to bring it into sharper focus - could be even up to c. 1.7million cases per year
More widely accepted estimate is 800,000 per year – still a huge number
Sepsis costs the NHS more to treat than asthma.
Cost to the NHS could be reduced massively by more effective treatment – misdiagnosis and inappropriate treatment causes complications which increase costs.
WHO estimate 6m lives lost per year (compare this to cancer 8.2m, tobacco 6m, ischaemic heart disease 7.2m)
UK Sepsis Trust is working to increase awareness and get the message out there with all sorts of organisations through advertising ‘Just ask could it be sepsis’
Coronation Street sepsis story line, also working with the FA to access schools and educate children.
Why? Because we have to get our patients to ask the question ‘could it be sepsis’
Together we can save 14,000 lives.

Meeting the Quality Standards in Practice: Quality Measures
Jacqui Jones
, Sepsis Specialist Nurse, James Cook University Hospital, Chair, UK Sepsis Nurse Forum

Surviving Sepsis: The Patient Perspective
Phil Crow,
Sepsis Survivor
Phil Crow is a freelance commercial photographer. Based in Lincoln, he has worked there for over 25 years. He has work with a wide range of clients from flying with the Red Arrows to shooting editorial portraits of Jamie Cullum and Sir Robert Winston to name a few. 
Pre event abstract: A Patient Perspective
"So, Doctor, how long will I need off work?"
"Hmm... you're self employed aren't you"
"Yes"
"Oh, no doubt you'll be back to work the following day!"
"Out of curiosity, if I was an employee, how long would I have off?"
"Oh, you'd be signed of for at least 4 weeks on full pay."

Says it all doesn't it! And so it began. On the 15 July 2010, I was admitted for my ERCP which is where it all went wrong 
Diagnosis: gallstones, choledocholithiasis, acute pancreatitis, biliary peritonitis, retro-peritoneal abcess, sepsis
I’ll be touching on my experience in hospital but concentrating on “life after sepsis” 
looking at how my family and I coped with PTSD and how it still has impact on us 7 years later. The pros and cons of self employment and rebuilding a business post SepsisHealth condition after sepsis… what happened next. Legal eagles- the fundamentals of ongoing legalities and what could improve a system not built for sepsis survivors.

Root Cause Analysis, Clinical incident reporting and Sepsis
Mike O’Connell
, Legal Services Practitioner
Pre event abstract
This session explores: Effectively using root cause analysis and clinical incident reporting around Sepsis, improving risk management practice and documentation to improve future care for patients, and provides a legal update and lessons from cases. The NHS England Serious Incident Framework: Supporting learning to prevent recurrence document sets out the framework for undertaking root cause analysis investigations of Serious Incidents (SIs). SIs are classed as events in health care where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant, that they warrant using additional resources to mount a comprehensive response. Root Cause Analysis (RCA) is “an evidenced based, structured investigation process which utilises tools and techniques to identify the true causes of an incident or problem, by understanding what, why and how a system failed.” The RCA investigation process involves: Identifying the problem; Gathering and mapping information; Analysing information; and Generating solutions. From a patient perspective, Being Open has now been supplemented by the Duty of Candour; involvement in the investigation and sharing the outcome are key elements. Practical tips in this session include: close attention to detail, use of straightforward language, ensuring adequate time for completion of a thorough and comprehensive investigation, and useful lessons on links with HM Coroners’ and others’ investigations. RCA generic recurring themes include failures to note deterioration, to escalate, to diagnose, to document/act on NEWS, or to document effectively.
The session also sets out key messages from a High Court case (XYZ v. Maidstone & Tunbridge Wells NHS Trust); NHS Resolution (Sign up to Safety incentivisation scheme); Care Quality Commission (“Learning from serious incidents in NHS acute hospitals: A review of the quality of investigation reports”); and Healthcare Safety Investigation Branch (Interim bulletin: “Recognising and responding to critically unwell patients”). 
Full powerpoint presentation

Improving the identification and management of pre-hospital Sepsis
Helen Lambert
, Clinical Support Manager, East Midlands Ambulance Service
Pre event abstract
Sepsis is one of the most common causes of death, carrying high mortality and morbidity rates. Initial presentation is often non-specific, making diagnosis pre-hospital a challenge. Emergency calls to patients presenting with sepsis are among the highest number of calls received by Ambulance Services, with up to 88% of patients diagnosed with sepsis arriving at an emergency department via Ambulance. I conducted a critical literature review (CLR) with the aim of evaluating current literature to establish if pre-hospital recognition of sepsis in adults is adequate, while determining any impact pre-hospital recognition has on mortality.
Ten quantitative studies were identified as containing pertinent content and methodology to support the review questions. A CLR was fulfilled using a systematic approach in-order to answer well defined research questions. Varying components of pre-hospital recognition of sepsis and mortality factors were described. Several studies analysed novel sepsis screening tools, lactate monitoring pre-hospital, time to antibiotics and in-hospital mortality. Each study was examined for academic rigor while detailing independent methodological transparency.  
The main findings of the CLR indicated that Sepsis screening tools (SST) enhance recognition of sepsis when introduced in line with education. The addition of a lactate monitor in conjunction with a SST further aids recognition, in particular for cryptic shock and septic shock.  Education and improved recognition could increase pre-alerts to hospital, ultimately reducing time to antibiotics and mortality. Time to antibiotics in sepsis was seen to be shorter when transported by Emergency Medical Services (EMS), albeit in-hospital mortality was higher. This was attributed to patients presenting pre-hospital being older and far sicker.
Full powerpoint presentation

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13 July 2018

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