I’ve known Karen ever since we met in such awful circumstances, and she, too, is resolved to ensure that fewer families have to go through what hers is going through. For her, and for her children, bereavement is ongoing- there is no finite period after which they can dust themselves off and move on. Sure, they live and enjoy their lives, but every day they think of their Jem.
Like me, Karen continues to ask why? Why Jem, how did this happen, and why is it still happening every day. As I write this blog entry, I read in the Daily Mail today the story of a 4 year old girl who died in Kingston. Her junior doctor knew something was seriously wrong, but the senior medics laughed at her- actually laughed at her- when she suggested a Consultant should see her. The girl later died of septic shock.
Her junior doctor knew something was seriously wrong…
After Jem died, I began to think long and hard about how we could address the issue. At the time, I was thinking about patients arriving at Good Hope Hospital- my professional world had yet to expand. Earlier that year, I’d been to the launch of the Surviving Sepsis Campaign in the United Kingdom (along with many other Intensive Care Unit (ICU) doctors and nurses), and it seemed that these international guidelines would be a good place to start. So I signed up to the Surviving Sepsis Campaign’s UK Steering Group. We got materials, care bundles (packages of care detailing best practice), a database, and some audit tools- all great and useful in Intensive Care, and possibly in a fully-equipped North American Emergency Department, but difficult to translate into practice outside those environments.
The next step, I felt, was education. I started planning this with Sam, one of our Critical Care Outreach sisters. Together, we began to develop an in-house education programme called ‘STOP Sepsis’, which we started delivering in 2006. Those early days taught us a lot. Very early on, we hit on the problem that the SSC care bundles were too complex. As soon as we started talking to doctors and nurses outside ICU about ‘central lines’ (a line placed in the neck to monitor the function of the heart and circulation) and the like, we hit a brick wall.
Hitting on Survive Sepsis and the Sepsis Six.
Two things then happened. First, I went over to an international meeting in Brussels and met up with a great guy called Mitchell Levy, the head of the Surviving Sepsis Campaign (SSC), who was over from the U.S.
Laden with powerpoint presentations and a rudimentary ‘manual’, I asked him if the SSC might endorse or support STOP Sepsis. This brought about my first lesson in medical politics, and was also one of many lessons along this journey in how not to be disheartened by a knock-back. “No!” came the emphatic answer, “that’s the same as Loma Linda- you can’t call it that”. After a moment of panic, and pretending to know who Loma Linda was (I later discovered it’s a ‘what’ not a ‘who’: a university hospital which had set up a programme competing with the SSC), I offered “how about if we call it Survive Sepsis?”. And so Survive Sepsis was born, and so received the official endorsement of the Surviving Sepsis Campaign.
Second, Sam and I built a larger group at Good Hope to brainstorm ideas. First and foremost, what could a junior doctor and junior nurse do to help patients with sepsis, and to help us in ICU to deliver the Surviving Sepsis Campaign bundles? It was clear that simplicity, in a stretched and highly pressured clinical environment, was the key. We sat down with Katy and Tim (2 of our junior doctors) and George (another Critical Care Outreach sister) to identify simple tasks like giving antibiotics and fluid challenges which juniors could deliver and, more importantly, would want to deliver. After a couple of hours, the Sepsis Six was born..
The next time I blog, it will begin to describe how we turned the Sepsis Six and Survive Sepsis into exportable products, and how we started to turn them into national entities. Little did I know what would happen!