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Sepsis Policy-Apsley Surgery
https://www.nhs.uk/conditions/sepsis/

What is sepsis?

Sepsis is a term used to describe the body’s abnormal response to infection. The international definition of sepsis is 'life-threatening organ dysfunction caused by a dysregulated host response to infection'. The effects are from the body’s toxic response to the infection.

The Sepsis Alliance defines it as 'the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death. In other words, it’s your body’s overactive and toxic response to an infection.' Sepsis affects many different organs so it can be hard to spot. A full set of physical observations can support clinical judgement to make this difficult diagnosis.

It can affect anyone but is more common in people who have a weakened immune system, a long-term condition, are very young or are frail. The incidence is particularly high in patients with a learning disability. It can be catastrophic if undetected and untreated; leading to multi-organ damage and The UK Sepsis Trust estimates it leads to 52,000 deaths each year in the UK.

Practice Staff must be aware of sepsis and be able to demonstrate how an acutely unwell or deteriorating patient is managed before and during an appointment, including any ongoing referral or care.

Symptoms

Symptoms of sepsis for babies and young children may include:



    • abnormal temperature – low as well as high

    • difficulty breathing

    • lack of interest in eating and drinking, or have stopped feeding

    • not passing urine for 12 hours or longer

    • repeated vomiting

    • change in mental state including unresponsiveness or agitation

    • irritability

    • mottled pale or bluish skin, or a rash that does not fade when pressed



Parental concern is another key feature that needs to be considered.

Symptoms for adults and older children may include: feeling extremely unwell



    • abnormal temperature – low as well as high

    • chills and shivering

    • a fast heartbeat

    • fast breathing

    • feeling dizzy or faint

    • decreased urine production

    • a change in mental state, such as confusion, disorientation or agitation



Early identification of sepsis

The 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report Just Say Sepsis highlights the importance of accurate early assessment and recording and sharing clinical findings.

Physiological assessments

These are an important part of clinical assessment and include:



    • pulse

    • temperature

    • blood pressure*

    • respiratory rate*

    • oxygen saturations



These should be performed when a patient presents with an acute illness, or a deteriorating preexisting condition, particularly where sepsis is suspected. General Practice Sepsis Screening and Action tool laminated in all rooms.

Also abnormal readings recorded on EMIS in clinical notes will flag up a RED Flags Sepsis alert as follows:

Red Flag Sepsis

This is Time Critical: immediate action is required.

Immediate actions if escalation of care appropriate



    • Dial (9) 999

    • Ask for Blue light- advising suspected Sepsis

    • Administer oxygen to maintain saturations >94%

    • If estimated transfer time over 1hr – administer Benzylpenicllin IM

    • Ensure adequate information provided to ambulance crew.



* A raised respiratory rate, poor perfusion or low blood pressure and new onset confusion offer a higher predictive value than the other measures. They are particularly important to record.

National Early Warning Score (NEWS2) is used by all hospitals and ambulance services in England as a tool for identifying patients with sepsis. If GPs score patients using NEWS2 it can form part of a common language to describe concern and track deterioration. Early indications are that mortality from sepsis falls at sites using scoring systems routinely at patient handover. This is available as an EMIS template if clinicians feel it is appropriate to use.

 

 

Telephone or online consultation

It is difficult to assess unwell people with infection indirectly. There should be a low threshold for progressing to a face to face assessment. If sepsis is a significant possibility, consider bypassing a primary care face-to-face assessment and admit to hospital urgently.

Safety netting

If patients show signs of infection, but not sepsis, give clear and specific advice about what to do next. Ideally, give this in writing. This makes sure patients with unresolved or worsening symptoms know when and how to get further advice.

Educating Patients

Information available for patients on website and in waiting room both on TV screen, and patient leaflets, raising awareness of Sepsis.

 

 
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