The NHS's fight against sepsis stepped up a gear on 1 April 2019, when its standard contract was amended to require all NHS Trusts in England to comply with sepsis guidance that was first published in September 2017.
The guidance, entitled "Sepsis Guidance Implementation Advice for Adults", was drawn up by NHS England in collaboration with NICE, the Royal Colleges of GPs and Physicians, and also the UK Sepsis Trust.
Some of the key points in the guidance are:
- Clinicians should aim to suspect sepsis at an early stage and initiate treatment promptly, because, although it is not always easy to diagnose sepsis in its early stages, by the time it reaches an advanced stage it is associated with very high mortality.
- The use of the National Early Warning Score ("NEWS") system is recommended. NEWS allocates a score to six physiological measurements (respiration, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness or new confusion, and temperature) in order to track patients' clinical condition, alert the clinicians to any clinical deterioration and trigger a timely clinical response. It was first launched in 2012 and was updated to NEWS2 in 2017.
- A NEWS score of 5 or more indicates that the patient is severely ill with likely organ dysfunction and that urgent assessment by a senior doctor is required. If sepsis is suspected, the doctor, exercising clinical judgment, should start the patient on intravenous antibiotics (if there is evidence of bacterial infection), supplemental oxygen and an intravenous fluid bolus (if there is any sign of circulatory insufficiency).
- The guidance warns that patients with a NEWS score of less than 5 may nonetheless have sepsis (or be at risk of developing it) and that clinicians should still be alert to certain indicators that might indicate that the patient is at high risk of sepsis, despite a NEWS score of lower than 5. For example, a non-blanching rash or mottled, ashen or cyanotic skin, or an unresponsive patient.
- There is no evidence of any test that can confirm or exclude sepsis in the timeframe within which treatment should be started for sick patients, so treatment must not be delayed pending receipt of the results of any testing.
- Patients who are treated for sepsis with intravenous antibiotics and/or fluid boluses, and who do not respond to treatment within one hour, should be urgently discussed with or seen by a consultant.
This guidance, and the contractual obligation that has now been placed on NHS Trust's to comply with it, is just one part of the objective set out in the NHS Long Term Plan to ensure that patients presenting at hospitals with the most serious illness and injuries are given the best possible care in the shortest possible time, potentially saving thousands of lives.
As well as saving lives and avoiding serious injury, compliance with NHS England's guidance is also likely to result in a reduction in claims relating to alleged delay in the diagnosis and treatment of sepsis, thereby potentially saving millions of pounds for the NHS. NEWS charts, if properly completed, will form important documentary evidence that will demonstrate that the clinicians appropriately monitored the patient and acted upon any clinical deterioration. This evidence will greatly assist in defending claims and will help avoid the circumstances that give rise to claims arising in the first place.