Sepsis care and prevention at Doncaster and Bassetlaw Teaching Hospitals (DBTH) is set for significant development, thanks to over £50,000 in charitable funding dedicated to enhancing sepsis nursing roles and training.
Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
In the UK alone, 245,000 people are affected by sepsis with at least 48,000 people losing their lives in sepsis-related illnesses every year. Sepsis claims more lives than breast, bowel and prostate cancer put together.
Marie Hardacre, Associate Chief Nurse for Patient Safety and Quality, said: “When developing our safety improvement plans at DBTH, improving the recognition and treatment of sepsis was a priority. There’s no one sign of sepsis and symptoms present differently in adults and children. Sepsis could affect any one of us. With 40% of sepsis survivors suffering permanent, life changing after-effects.”
The ‘Sepsis Six Care Bundle’ is a set of six tasks developed by the UK Sepsis Trust to be followed by healthcare practitioners if the sepsis screening tool identifies a person is high risk. The specific measurements and care plan to follow include the monitoring of oxygen, cultures, antibiotics, fluids, lactate measurement and urine output.
These steps have been shown to reduce the relative risk of death by 46.6% when delivered to patients with severe sepsis within one hour, according to the UK Sepsis Trust.
Marie continued: “The more people who know and understand about the warning signs of sepsis the more deaths can be prevented. The improvement plan focuses on all the team at DBTH and includes increasing knowledge and awareness of sepsis and how essential it is that the sepsis six screening tool is used.”
Following the introduction of the sepsis action group in July 2023, Marie applied for £50,000 from Doncaster and Bassetlaw Teaching Hospitals Charity to fund two sepsis nurse specialists, one for adults and one for paediatrics.
Beth Vincent, who has now been in post as the Sepsis Nurse Specialist for Paediatrics for 11 months, said: “I chose to take up the post because I am passionate about improving patient care.
“I thought the role would provide a good opportunity to collaborate with the multi-disciplinary team to hear their voices and develop actions to improve sepsis care for our Trust.”
The Sepsis Nurse Specialist for adults is Heather Holt, who works as a sister on the Haematology ward at Doncaster Royal Infirmary and has been in her sepsis specialist role for roughly one month.
Introducing the two sepsis nurse specialists has already had a profound impact on the early identification of sepsis, as well as raising awareness to colleagues, Beth explained.
She said: “We’ve already made positive changes to sepsis care in paediatrics such as implementing the ‘Sepsis Response Boxes’, ‘Paediatric Sepsis Roadshows’ and ‘Sepsis Padlet’.”
The Sepsis Response Boxes are a tool to support effective management of the septic child quickly. Everything required for the sepsis six pathway is available within it, Beth explained.
She continued: “We have had positive feedback from doctors and nurses to say that this has been a great implementation and makes a difference when managing a septic child.”
Dr Hugh Wilson, Acute Consultant in Adult Care and Trust Clinical sepsis lead, explained how the mortality rate from sepsis within the Trust has been falling.
He said: “Paediatrics has made great progress with the appointment of Bethany as the specialist nurse in sepsis. Bethany’s work has been extremely valuable in improving sepsis care in the Emergency Department (ED) and Paediatrics.”
Dr Wilson explained how the sepsis action group produced several electronic aids to help clinicians identify and treat sepsis.
This includes the sepsis ‘Live Tracker’ in ED, the sepsis Interdisciplinary Plan of Care (IPOC) applied on Nerve centre and Symphony systems which alert to sepsis, and the sepsis dashboard, an audit tool to read the sepsis care performance of individual departments and the whole Trust.
The Acute Medical Unit (AMU) patient tracker highlights patients who have a high ‘NEWS’ score and are therefore the sickest, alerting the clinician to respond to them first.
Dr Wilson said: “The AMU patient tracker has changed the culture in AMU and has led to patients being seen more quickly with the sickest septic patients receiving priority.”
The sepsis action group have also introduced a ‘sepsis bloods requesting tab’ in ‘ICE’ – a system for clinicians to request diagnostic tests and view pathology results.
Dr Wilson continued: “We have been very lucky to appoint Heather Holt as our sepsis specialist nurse for adult patients. Heather is leading Quality Improvement work, teaching and training our staff on wards.”
Laura Churm, Divisional Nurse for Paediatrics, said: “Introducing Bethany as our sepsis specialist nurse in Paediatrics has had a positive impact on our ability to improve sepsis care within the Trust.
“Bethany brings a huge amount of specialist knowledge to the role. She shares this knowledge with colleagues to make our approach to sepsis cohesive and robust.
“In particular, she has helped to implement Sepsis Response Boxes which has enables us deliver treatment as quickly as possible.
“From a personal perspective, I am incredibly proud to have been involved in the implementation of a role so instrumental to patient care.”
Marie also applied for £2,500 in funding for online sepsis training for staff. Prior to this, sepsis was taught as part of other courses, making the dedicated sepsis training the first of its kind in the Trust.
The three modules, purchased from the UK Sepsis Trust, consist of an introduction to sepsis, adult sepsis and paediatric sepsis.
They are accessible to healthcare assistants (HCA), trainee assistant practitioners (TAP) and clinical support workers, as well as all medical and nursing teams, completing the module most relevant to their role.
Nicola Vickers, Clinical Education Manager for DBTH, said: “These dedicated sepsis e-learning modules are the first-of-their-kind in the Trust. What makes our approach unique is that every single member of DBTH, clinical or not, is required to complete them.
“It is important for all colleagues at all levels to understand the effect of sepsis on our communities and the impact on our workflow as an organisation.
“Spotting the early signs of sepsis is a useful skill for anyone working in, or linked to, health and social care.”
The Health Education England programme, ‘Think Sepsis’, is also included in the e-learning and is aimed at improving the diagnosis and management of those with sepsis.
Dr Ken Agwuh, Director of Infection and Control, and a member of the Sepsis Action Group, said: “As a Trust we are committed to getting it right the first time with Sepsis. We know the importance of early identification, diagnosis and management of this syndrome.
“With “Think sepsis”, we encourage our healthcare workers to consider the diagnosis of sepsis for every patient that presents in our emergency units acutely unwell or with an acute deterioration while on our wards.”
