Quality standard

Quality statement 4: Recognising and treating sepsis

Quality statement

Pregnant women in labour with sepsis have an immediate review by a senior clinical decision maker and antibiotics given within 1 hour if indicated.

Rationale

Physiological changes during labour may mask the early signs of sepsis. Sepsis is a medical emergency and needs urgent review from a senior clinical decision maker. The team determines whether antibiotics are needed as part of initial management, and they should be given within 1 hour of the signs of sepsis being recognised, if needed. Sepsis is associated with maternal and neonatal mortality. Unwarranted antibiotic treatment may, however, pose an unnecessary risk to the unborn baby, so senior review before prescribing is important.

Quality measures

Structure

a) Evidence of local arrangements to support escalation protocols to ensure that pregnant women in labour with sepsis are transferred from home birth and midwifery-led units to an acute setting for review and start antibiotic treatment (if indicated) within 1 hour.

Data source: Local data collection, for example, local network agreements and transfer protocols.

b) Evidence of local arrangements to ensure availability of, or access to, a senior clinical decision maker for pregnant women in labour with sepsis to have an immediate review.

Data source: Local data collection, for example, local network agreements, transfer protocols and staff rotas.

c) Evidence of local arrangements to start antibiotic treatment, if indicated, for pregnant women in labour with sepsis within 1 hour.

Data source: Local data collection, for example, system specifications and maternity record systems.

d) Evidence of local arrangements to document the decision to start antibiotic treatment for pregnant women in labour with sepsis.

Data source: Local data collection, for example, system specifications and maternity records.

Process

a) Proportion of pregnant women in labour with sepsis who have an immediate review by a senior clinical decision maker.

Numerator – the number in the denominator who have an immediate review by a senior clinical decision maker.

Denominator – the number of pregnant women in labour with sepsis.

Data source: Local data collection, for example, an audit of maternity records.

b) Proportion of pregnant women in labour with sepsis who started antibiotics within 1 hour.

Numerator – the number in the denominator who started antibiotics within 1 hour.

Denominator – the number of pregnant women in labour with sepsis who needed antibiotics.

Data source: Local data collection, for example, an audit of maternity records.

c) Proportion of pregnant women in labour with sepsis who had the rationale for the decision to start antibiotics documented.

Numerator – the number in the denominator who had the rationale for the decision to start antibiotics documented.

Denominator – the number of pregnant women in labour with sepsis who had antibiotics.

Data source: Local data collection, for example, an audit of maternity records.

What the quality statement means for different audiences

Service providers (NHS hospital trusts) ensure that protocols, systems and pathways are in place for pregnant women in labour with sepsis to have an immediate review by a senior clinical decision maker and receive the first dose of antibiotics, if indicated, within a 1-hour timeframe. They also ensure that a senior clinical decision maker is available to perform the review and protocols are in place to document the rationale for the decision to start antibiotics.

Healthcare professionals (such as a doctor of grade core trainee 3 [CT3] or above, specialty trainee 3 [ST3] or above or an advanced nurse practitioner with antibiotic prescribing responsibilities in discussion with the consultant under whose care the woman is admitted, or a consultant covering acute medicine or anaesthetics) review pregnant women in labour with sepsis immediately. They decide whether to give antibiotics (or not) based on this review, and administer the first dose of antibiotics, if indicated, within the 1-hour timeframe. They also document the rationale for the decision to start antibiotics.

Commissioners (clinical commissioning groups) ensure that they commission services that have protocols, systems and pathways for pregnant women in labour with sepsis to have an immediate review by a senior clinical decision maker and antibiotics given within 1 hour, if indicated. They also ensure that services have capacity to perform the review and have protocols in place to document the rationale for the decision to start antibiotics

Pregnant women with sepsis are assessed by a senior healthcare professional as soon as the early signs of sepsis are recognised. As part of this assessment, a decision is made about whether antibiotics are needed, and if they are, they are started within an hour.

Definitions of terms used in this quality statement

Senior clinical decision maker

A healthcare professional who is authorised to prescribe antibiotics, such as a doctor of grade core trainee 3 (CT3) or above, or a specialty trainee 3 (ST3) or above. Equivalent roles include an advanced nurse practitioner with antibiotic prescribing responsibilities, depending on local arrangements. The senior clinical review should involve discussion with a consultant. This is the consultant under whose care the woman is admitted, or a consultant covering acute medicine or anaesthetics. [NICE's guideline on sepsis recommendation 1.6.1, footnotes]