Managing Deteriorating Conditions
Sepsis+ Update
Considerable work has been delivered across the country over the past few years, supported by CQUIN, to improve the identification and treatment of acute illness. Over the past two years this work has drawn attention to the importance of timely escalation and its inclusion in CQUIN uses evidence based best practice to improve consistency in the recording and response to deterioration. The simple steps identified will draw on learning from early adopters to standardise the approach to identification and recording of deterioration across the country, enabling swifter response, which will reduce the rate of cardiac arrest and reduce the rate of preventable deaths in England.
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 Implementation Advice for Adults", that was first published in September 2017. In 2020 this has been further ramped up with new guidelines brought in from April, and NEWS2 results being recording as part of the national CQUIN.
The use of the National Early Warning Score ("NEWS") system is now no longer just advisory. 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.
Greater understanding and research studies have highlighted there is much to do for the sepsis survivor post-treatment, with many cases of reinfection within the first 12 months, and of psychological stress disorders which have led to suicide.
The new guidance, and the contractual obligation that has now been placed on NHS provider organisations 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.
Antimicrobial resistance (AMR) is a growing threat to population health. It has been predicted to be responsible for ten million deaths every year by 2050 and has the potential to jeopardise many interventions that are central to modern healthcare. Reducing unnecessary prescribing through antimicrobial stewardship is an import component of the strategy to reduce AMR
Concurrently, there has been growing awareness of the need for earlier recognition and management of sepsis, a serious consequence of untreated bacterial infection that is associated with high mortality that can initially present with seemingly minor symptoms. Early administration of broad-spectrum antibiotics is vital in managing suspected sepsis but making a definitive diagnosis is difficult, particularly in community settings where the majority of antibiotics are prescribed.
In Birmingham in June we will review the strategies and solutions required to provide a national and local response to AMR and the management of deteriorating conditions. We will also showcase the latest innovation and technology within our networking exhibition
"We need to use cutting-edge technology to deliver safe, high quality and patient-centred care. And we need to use transparent open data to be able to spot anomalies that might indicate systemic failures. We're moving towards the full roll-out of electronic prescribing and medicines administration in secondary care to extend inter-operability and reduce medication-related error.
Our new Patient Safety Incident Management System will improve how we capture and spread the insight that we can gain from incident reporting in the NHS, harnessing the new opportunities for analysis that machine learning can offer, to ensure our safety intelligence remains cutting edge.
And we must – we must – improve the way we spot sepsis and save lives starting with our new 'suspicion of sepsis dashboard'. Sepsis is such a devastating condition and I've been so incredibly moved to listen to stories from families who have lost loved ones. We must do all we can to stop it.
The new dashboard will measure the number of patients who come to hospital with serious infections, and give quick information so doctors can see which of those infections cause patients to deteriorate very quickly and help them understand which treatments are most effective, and how to intervene quickly.
In the future, all this data will be used to help analyse which infections most often lead to sepsis. It is yet another example of how technology has the potential to improve patient care in the NHS when we can get the systems to talk to each other. And I'd like to thank the clinicians and experts at Imperial who have helped develop it. It is the next step in the NHS's fight against sepsis. But we need to go further."
Matt Hancock-Secretary of State for Health and Social Care
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