Every year in the UK there are 150,000 cases of Sepsis, resulting in a staggering 44,000 deaths – more than bowel, breast and prostate cancer combined. To reduce mortality treatment in the first hour is vital. The research and evidence shows that when IV antibiotics are administered to a septic patient within one hour, the mortality is reduced by half but if not the mortality increases by 8% for every hour of delay in antibiotic administration. Last April we started a Sepsis project at the James Paget University Hospital with the aim to try to improve Sepsis outcomes at the trust.
First three months we did an extensive work engaging with staff and also to evaluate how well we were performing. The trust completed an extensive audit which provided a baseline result and enabled the team to reach a starting point for the improvement project. An extensive process-mapping exercise was completed, looking at current processes and protocols to identify barriers and obstacles that were preventing the trust from achieving the highest standard. Our goal was to make it easy for staff to identify sepsis and provide clarity regarding what they should do afterwards. For that reason we introduced very simple changes and we avoided new paperwork for clinicians to fill in - in fact we removed some of the paperwork as a result of streamlining the pathway. A key success was also creating a pathway where everyone felt involved. We set up a sepsis group which runs across different departments. The new pathway is designed for anyone to understand and was design and lead by the frontline.
We realised that Nursing and Health Care Assistants play a vital part in identifying sepsis and we have empowered them with tools and resources to lead early identification of Sepsis. We’ve also empowered the Clinical Care Outreach Team (CCORT) and the Hospital at Night Practitioners to administer antibiotics by utilising a Patient Group Directive (PGD), previously only doctors were allowed to prescribe the antibiotics which could create delays if the doctor was tied up with another sick patient. Innovations in the programme were designed and created by the frontline staff and approved by the sepsis group. The Easy guides, prompt cards and Sepsis badges have made a tremendous impact on the speed that staff recognises Sepsis. Other measures included putting together a sepsis pack with a step-by step guide and redesigning the hospital observation chart to include a “sepsis recognition box”. Other initiatives proposed were to do a sepsis huddle after every ward round to ensure that every patient was properly assessed. A simple question is asked on the sepsis huddles: do any of the patients have an EWS score of 3 or above? The total cost of the Sepsis project has cost just under £500. We have produced all our material like posters and videos in house and the only thing we have outsourced have been the production of Staff Prompt Cards, Badges and printing new simplify Sepsis 6 forms.
1- Think Sepsis Culture amongst frontline. All staff just just follow a simple rule: Does your patient have an EWS 3 or above? Think Sepsis.
2- Increased % of patient receiving antibiotics inside 60 minutes as per Nice Guidance from just 63% to 87% of our patients.
3- Reduction length of stay for Septic Patients by 3.3 days
4- Reduction Sepsis related crude mortality by 2.4%. Now our Sepsis mortality rate is 12.1% well below the national average that stands at 16.8%
5- Reduction of readmissions from patients discharged diagnosed with Sepsis. Data Source: Dr Foster Healthcare Intelligence Portal.
To spread the project, we’ve branded the campaign and used Social Media. We’ve also held two Sepsis awareness weeks to share the progress and achievements. We have gone all across hospital doing pop up quick teaching sessions and presented in ward meetings. We’ve published our achievements on the NHS improvement website and at the Academy of Fabulous Stuff. We’ve also featured in the Nursing Times, with an article on our project being the most read in May. Our Sepsis Project has raised a lot of interest across several trusts and resources have been shared with everyone who has requested them.