Most patients identified with life-threatening sepsis are now being reviewed within 30 minutes thanks to new screening tools launched at Waikato Hospital this spring.
Waikato District Health Board’s Sepsis Action Group launched the new clinical tools on World Sepsis Day (13 September 2018). The tools, not only help frontline staff more quickly identify patients arriving at ED with potentially deadly sepsis but also sets out the ‘Sepsis Six’ which are the six key life-saving steps clinicians should take once ‘red flag’ sepsis is identified. (See below)
Dr Dan Dobbins, an emergency medicine physician, action group member and co-founder of the New Zealand Sepsis Trust, said increased awareness, education and new screening tools – core parts of the DHB’s sepsis improvement programme – were already making a difference.
Since the September launch every adult patient with sepsis at Waikato DHB had seen a doctor within 60 minutes and most within 30 minutes compared to up to six hours pre-launch. Before the launch, in the 12 months to June 2018, there were 659 adult sepsis cases admitted to Waikato hospitals and more than one in five patients with sepsis died in-hospital – a greater than 20 per cent mortality rate. The group was hopeful that earlier review and treatment, resulting from the screening tools, would also mean shorter hospital stays and a better chance of survival.
In just 49 days (from the launch on 13 September to 31 October), a total of 68 patients were recognised and admitted to Critical Care with sepsis, predominately (80%) through Waikato Hospital’s Emergency Department (ED).
Dobbins said the quicker identification and response times were due to the work of the action group over the last few years combined with the efforts of frontline ED staff – in particular advocates like registered nurse and sepsis survivor Paige Nicholson and senior registered nurse Maria Baxendine.
Sepsis – which has also been called ‘septicaemia’ or sometimes ‘blood poisoning’ – is caused by an extreme immune system response to an infection for example pneumonia, a bladder infection, a skin infection or a bloodstream infection (bacteremia).
Only a small number of infections lead to sepsis with just two per cent of people admitted to hospital having sepsis compared to 25 per cent of hospital admissions being due to infections of all types.
Waikato DHB’s director of infectious diseases, Sepsis Trust trustee and action group chair Dr Paul Huggan said sepsis can be difficult to detect in its early stages, so clear guidelines, education and support for frontline staff was critical.
“It’s taken a lot of research, time and effort from a large collective of people to get the new clinical tools out there. By gathering information on sepsis care continuously, we’ve also been able to make changes to the programme as we go along. The response from colleagues has been fantastic. They feel much more confident that they’ll be able to take the right steps when faced with a sepsis patient and are taking the time to ask “could it be sepsis?”
Huggan added that there was still a long way to go as the data to date only looked at adult patients at Waikato Hospital and he was confident that “thousands of New Zealanders are dying very year from sepsis”.
Waikato data for child cases of sepsis in the 12 months to June 30 2018 was 17 cases with also a high mortality rate of 18 per cent.
Waikato DHB’s sepsis clinical nurse coordinator Odette Paul says, “We’re not sure that we’re counting cases of sepsis in children properly. Even so, it is important to do our best to improve sepsis care in children because it’s still a high risk condition. Kids compensate well and look like they’re doing OK but they can go downhill really quickly.”
The Waikato Action Group set up the New Zealand Sepsis Trust to build awareness amongst both frontline health staff and the public about sepsis which it says kills more people than lung, breast and bowel cancer combined. The trust aims to promote clinical tools and to provide education and fundraising to build awareness and sepsis research capability.
The ‘Sepsis Six’ action for when Red Flag Sepsis is Diagnosed
- Administer oxygen
- Take blood cultures
- Give IV antibiotics
- Give IV fluids
- Check serial lactates
- Measure urine output
(NB all six to be completed within 1 hour)
Clinical symptoms of Sepsis
- Signs of infection
- Very low blood pressure (Systolic B.P ≤ 90 mmHg)
- Very fast heart rate ( > 130 per minute)
- Rapid breathing (25 breaths per minute or more)
- Low levels of oxygen in blood (i.e. needs oxygen to keep SpO2 ≥92%)
- A reduced level of consciousness
- High levels of lactic acid in the blood (Lactate ≥2 mmol/l)
SEPSIS – people usually experience one or more of below symptoms
Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (for a day)
It feels like you are going to die
Skin mottled or discoloured