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Sepsis: recognition, diagnosis and early management [NG51]

Measuring the use of this guidance

Recommendation: 1.1.8

Consider using an early warning score to assess people with suspected sepsis in acute hospital settings.

What was measured: The proportion of patients who developed hospital-acquired infections that had an early warning score.
Data collection end: May 2014
85.5%
Number that met the criteria: 71 / 83
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.


Recommendation: 1.3.1

Assess temperature, heart rate, respiratory rate, blood pressure, level of consciousness and oxygen saturation in young people and adults with suspected sepsis.

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had their respiratory rate recorded on arrival in the emergency department.
Data collection end: December 2016
94%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had their oxygen saturation (SaO2) recorded on arrival in the emergency department.
Data collection end: December 2016
94%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had their blood pressure recorded on arrival in the emergency department.
Data collection end: December 2016
94%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had their temperature recorded on arrival in the emergency department.
Data collection end: December 2016
94%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had their heart rate recorded on arrival in the emergency department.
Data collection end: December 2016
94%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had their level of consciousness (AVPU or GCS) recorded on arrival in the emergency department.
Data collection end: December 2016
89%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17


Recommendation: 1.6.1

For adults, children and young people aged 12 years and over who have suspected sepsis and 1 or more high risk criteria: arrange for immediate review by the senior clinical decision maker to assess the person and think about alternative diagnoses to sepsis carry out a venous blood test for the following: blood gas including glucose and lactate measurement blood culture full blood count C-reactive protein urea and electrolytes creatinine a clotting screen give a broad-spectrum antimicrobial at the maximum recommended dose without delay (within 1 hour of identifying that they meet any high risk criteria in an acute hospital setting) in line with recommendations in section 1.7 discuss with a consultant.

What was measured: The proportion of patients who received antimicrobials within the first hour of severe sepsis identification.
Data collection end: May 2014
44.1%
Number that met the criteria: 90 / 204
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: The proportion of patients who received antimicrobials within the first hour of sepsis identification.
Data collection end: May 2014
36.9%
Number that met the criteria: 75 / 203
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had a serum lactate measurement obtained prior to leaving the emergency department.
Data collection end: December 2016
88.4%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who had blood cultures obtained prior to leaving the emergency department.
Data collection end: December 2016
80.5%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17


Recommendation: 1.7.1

Pre-alert secondary care (through GP or ambulance service) when any high risk criteria are met in a person with suspected sepsis outside of an acute hospital, and transfer them immediately.

What was measured: Proportion of hospitals which reported having a system for a pre-alert to be sent by primary care and/or ambulance trusts for incoming patients with sepsis.
Data collection end: May 2014
51.1%
Number that met the criteria: 95 / 186
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.


Recommendation: 1.7.2

Ensure urgent assessment mechanisms are in place to deliver antibiotics when any high risk criteria are met in secondary care (within 1 hour of meeting a high risk criterion in an acute hospital setting).

What was measured: Proportion of people aged 18 and over diagnosed with sepsis who were adminstered antibiotics within 1 hour in the emergency department.
Data collection end: December 2016
41.2%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17


Recommendation: 1.9.1

Give oxygen to achieve a target saturation of 94−98% for adult patients or 88−92% for those at risk of hypercapnic respiratory failure.

What was measured: The proportion of patients who required oxygen that received it promptly.
Data collection end: May 2014
90%
Number that met the criteria: 334 / 371
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: Proportion of people aged 18 and over diagnosed with sepsis in whom oxygen was initiated to maintain SaO2>94% before leaving the emergency department.
Data collection end: December 2016
58%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17


Recommendation: 1.11.1

Ensure a care team member is nominated to give information to families and carers, particularly in emergency situations such as in the emergency department. This should include: an explanation that the person has sepsis, and what this means an explanation of any investigations and the management plan regular and timely updates on treatment, care and progress.

What was measured: The proportion of patients provided with printed information about sepsis.
Data collection end: May 2014
5.6%
Number that met the criteria: 29 / 519
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.


Recommendation: 1.11.3

Give people with sepsis and their family members and carers opportunities to ask questions about diagnosis, treatment options, prognosis and complications. Be willing to repeat any information as needed.

What was measured: The proportion of patients with evidence of discussion in the case notes between healthcare professionals and relatives/carer/patient.
Data collection end: May 2014
66%
Number that met the criteria: 299 / 452
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.


Recommendation: 1.11.9

Ensure discharge notifications to GPs include the diagnosis of sepsis.

What was measured: The proportion of patients that had sepsis mentioned on their discharge summary.
Data collection end: May 2014
54%
Number that met the criteria: 264 / 490
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: The proportion of patients whose GP was given a copy of the discharge summary.
Data collection end: May 2014
98%
Number that met the criteria: 222 / 227
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.


Recommendation: 1.12.2

Ensure all healthcare professionals involved in triage or early management are given regular appropriate training in identifying, assessing and managing sepsis. This should include: risk stratification strategies local protocols for early treatments, including antibiotics and intravenous fluids criteria and pathways for escalation, in line with their health care setting.

What was measured: Proportion of hospitals which reported having a specific protocol/care pathway/bundle for recognition and management of patients with sepsis.
Data collection end: May 2014
66.1%
Number that met the criteria: 360 / 554
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: Proportion of hospitals which have a protocol to aid the recognition and early management of sepsis and which provide education for medical staff in the emergency department around sepsis recognition and management, including the use of the protocol.
Data collection end: May 2014
84.2%
Number that met the criteria: 149 / 177
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: Proportion of hospitals which have a protocol to aid the recognition and early management of sepsis and which provide education for nursing staff in the emergency department around sepsis recognition and management, including the use of the protocol.
Data collection end: May 2014
83.3%
Number that met the criteria: 150 / 180
Area covered: England and Wales
Source: National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis.

What was measured: Proportion of emergency departments that reported providing sepsis education for all staff.
Data collection end: December 2016
96%
Area covered: UK
Source: Royal College of Emergency Medicine: Severe sepsis and septic shock clinical audit 2016/17



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