With multiple agencies, including the World Health Organisation, recognising that the rapid identification and management of sepsis is a public health priority; every healthcare provider organisation should have a policy and/or pathway on sepsis.
If yours doesn’t have one, or uses an outdated version (e.g. using the SIRS criteria), why not lead its implementation or development? Identify the right people to speak to - typically safety or governance leads, or clinical champions.
Organise a meeting, download the relevant tool for your clinical area from our clinical tools page, and off you go.
If you come up against barriers, get in touch. We might be able to help.
The evidence suggests otherwise! Since NHS England introduced its CQuIN commissioning incentive to improve screening and antibiotic delivery for patients with sepsis across hospitals in April 2016, overall antibiotic consumption has remained steady and usage of very broad spectrum agents such as carbapenems has reduced by nearly 10%.
The good news is that antibiotics are being given earlier - mostly in Emergency Departments. We are getting better at managing sepsis!
This is dealt with in full in our narrative toolkits. In brief, in 2015 we recognised that identification of severe sepsis and septic shock (using the now ‘old’ sepsis-2 definition) was presenting challenges - we needed something which would empower often junior staff to act.
We looked for a solution within existing resource, and the logical solution seemed to be NEWS. We took the criteria from the sepsis-2 definition (such as high lactate) which we can readily measure at the bedside and added the parameters from NEWS which scored 3.
All stakeholders, including NHS England and the Royal Colleges, agreed that this represented a sick group of patients who should be treated - through a surrogate for a formal diagnosis, this approach was supported be NICE NG51 and stands firm in the context of the latest ‘official’ definition.
There are three great things about the sepsis-3 definition:
The narrative, that sepsis is a life-threatening condition arising when the body’s dysregulated response to infection causes organ dysfunction. This removed the old ambiguity about describing patients with some systemic signs but who were relatively well as having ‘sepsis’.
The new ‘official’ definition of organ dysfunction, using a change in SOFA (Sepsis-associated Organ Failure Assessment Score).
However, this is not readily measurable at the bedside! Dropping SIRS (the Systemic Inflammatory Response Syndrome) from the definition of SEPSIS - SIRS was over-sensitive and poorly specific
So yes, use the narrative and let’s not use SIRS to diagnose SEPSIS!
If you’re a researcher, a change in SOFA score is the most appropriate way to ensure you’re recruiting the right patients. But at the bedside, we need something simpler - we use Red Flag SEPSIS as an empowering surrogate.
There is nothing wrong with qSOFA, the ‘bedside’ test proposed by the International Consensus Definitions Task Force! It is based on some evidence, albeit via a retrospective analysis of a large dataset, but is not prospectively validated.
It’s important to note that the Task Force did NOT propose qSOFA as either a treatment prompt or as a diagnostic tool - it was an identifier of patients in whom to look for sepsis.
Because we already use NEWS in the UK, and because it has since been shown to be as useful as qSOFA, we feel we should stick with what we know. We didn’t want our healthcare assistants, nurses, midwives and doctors to be asked to measure general risk using one scoring system, and then sepsis risk with another using different thresholds!
If your organisation uses electronic observations, it’s perfectly appropriate for qSOFA to be added as a second tool to identify risk. If you can’t automate it, though, both we and NICE suggest you stick with NEWS.
We developed the Sepsis Six in 2005 as a bedside tool to help (often junior) health professionals deliver the basics of care rapidly and reliably.
It was drawn from the international guidelines developed by the ‘Surviving Sepsis’ Campaign, but we recognised that a 16 page document containing 58 individual guidelines was unlikely to transform practice!
We set about developing the Sepsis Six as an operational solution. In 2011, we published evidence showing it to be associated with a 50% reduction in mortality - findings which others have since replicated.
Why does the Sepsis Six work? Because it’s simple. It’s memorable, it’s evidence-based and it empowers all staff to act. For these reasons, the Sepsis Six is now being used in 30 countries around the world.