SPSP: Sepsis in Primary Care Collaborative. Dr Paul Davidson Associate Medical Director Primary Care NHS Highland

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1 SPSP: Sepsis in Primary Care Collaborative Dr Paul Davidson Associate Medical Director Primary Care NHS Highland

2 Collaborative Ambition Improve early recognition and timely delivery of evidence-based interventions, including use of the National Early Warning Score (NEWS) for adults and Paediatric Early Warning Score (PEWS) for children.

3 Collaborative Ambition Improve early recognition and timely delivery of evidence-based interventions, including use of the National Early Warning Score (NEWS) for adults and Paediatric Early Warning Score (PEWS) for children. Improve communication and collaboration across NHS teams managing patients with sepsis.

4 Collaborative Ambition Improve early recognition and timely delivery of evidence-based interventions, including use of the National Early Warning Score (NEWS) for adults and Paediatric Early Warning Score (PEWS) for children. Improve communication and collaboration across NHS teams managing patients with sepsis. Reduce delays to receiving optimal treatment.

5 Time to treatment counts Why bother?

6 Why bother? Time to treatment counts Diagnostic error is the most common reason for medico-legal claims against GPs.

7 Why bother? Time to treatment counts Diagnostic error is the most common reason for medico-legal claims against GPs. The most commonly missed diagnoses identified retrospectively include pneumonia and urinary tract infection or pyelonephritis

8 Why bother? Time to treatment counts Diagnostic error is the most common reason for medico-legal claims against GPs. The most commonly missed diagnoses identified retrospectively include pneumonia and urinary tract infection or pyelonephritis The majority of errors are caused by incomplete history taking and clinical examination

9 Why bother? Time to treatment counts Diagnostic error is the most common reason for medico-legal claims against GPs. The most commonly missed diagnoses identified retrospectively include pneumonia and urinary tract infection or pyelonephritis The majority of errors are caused by incomplete history taking and clinical examination Failure to detect the deteriorating patient

10 40% Safety related deaths - themes 35% 30% 25% 20% 15% 10% 5% 0% Other Equipment error Dysfunctional flow Deficient checking/oversight Failure to prevent (inc. Falls,PU,HAI,VTE,Suicide) Mismanaged deterioration Patient-Safety-Related Hospital Deaths in England: Thematic Analysis of Incidents Reported to a National Database,

11 Elevated NEWS is associated with increased levels of adverse outcomes. NEWS

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13 Sepsis Screening Sepsis Six 1. Deliver O2 (94-98% SpO2 or 88-92% in COPD) 2. Take blood cultures and consider source control 3. Give IV antibiotics according to local protocol 4. Start IV fluid resuscitation (min 500ml) and reassess 5. Check lactate & FBC 6. Commence accurate urine output measurement and consider urinary catheterisation All within one hour

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21 NEWS and Sepsis screening App

22 NHS board teams NHS Highland NHS Lothian Scottish Ambulance Service with NHS Greater Glasgow and Clyde (joint) Who s involved?

23 Highland Proposal To achieve 95% or greater reliability of the Sepsis Protocol across a town and rural cluster in NHS Highland by end of June 2018

24 Work on 5 key areas: Recognition What will it involve? - of deteriorating patient and sepsis

25 Work on 5 key areas: Recognition What will it involve? - of deteriorating patient and sepsis Person Centred Intervention - what intervention works in primary care

26 Work on 5 key areas: Recognition What will it involve? - of deteriorating patient and sepsis Person Centred Intervention - what intervention works in primary care Education - an educational package for clinicians

27 Work on 5 key areas: Recognition What will it involve? - of deteriorating patient and sepsis Person Centred Intervention - what intervention works in primary care Education - an educational package for clinicians Leadership and Communication - spread of agreed practice

28 Work on 5 key areas: Recognition What will it involve? - of deteriorating patient and sepsis Person Centred Intervention - what intervention works in primary care Education - an educational package for clinicians Leadership and Communication - spread of agreed practice IT and Data recording - continuous evaluation to expose success / failure

29 Autonomy No prejudged method or strategy NHSH and National SPSP Team will support Initial protocols available for your use and development Learning from East Highland Sepsis Trial Close connection with secondary care sepsis work

30 Impact Significant impact on patient outcome likely this will save lives Improved recognition of the deteriorating patient Will assist in addressing variation as envisioned in Realistic Medicine

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32 Sep 11 Nov 11 Jan 12 Mar 12 May 12 Jul 12 Sep 12 Nov 12 Jan 13 Mar 13 May 13 Jul 13 Sep 13 Nov 13 Jan 14 Mar 14 May 14 Jul 14 Sep 14 Nov 14 Jan 15 Mar 15 May 15 Jul 15 Sep 15 Nov 15 Jan 16 Mar 16 May 16 % Attainment NHS Scotland Percent of patients who are commenced on IV antibiotics within 1 hour of time zero

33 Sep 11 Nov 11 Jan 12 Mar 12 May 12 Jul 12 Sep 12 Nov 12 Jan 13 Mar 13 May 13 Jul 13 Sep 13 Nov 13 Jan 14 Mar 14 May 14 Jul 14 Sep 14 Nov 14 Jan 15 Mar 15 May 15 Jul 15 Sep 15 Nov 15 Jan 16 Mar 16 May 16 % Attainment NHS Scotland Percent of patients with Sepsis Six performed within 1 hour of time zero

34 Jan 11 Mar 11 May 11 Jul 11 Sep 11 Nov 11 Jan 12 Mar 12 May 12 Jul 12 Sep 12 Nov 12 Jan 13 Mar 13 May 13 Jul 13 Sep 13 Nov 13 Jan 14 Mar 14 May 14 Jul 14 Sep 14 Nov 14 Jan 15 Mar 15 May 15 Jul 15 Sep 15 Nov 15 Jan 16 Mar 16 % mortality % 30 day mortality of ICD-10 A40/ A41 35% Collaborative Launch 30% 25% 20% 15% Mean 1: 24.8% 10% 5% 0% Mean 2: 19.5% 24.8% to 19.5% is a 21% reduction post collaborative launch Month

35 More information NICE Guideline 51: Sepsis RCGP Sepsis Toolkit: UK Sepsis Trust: sepsistrust.org FEAT: SPSP website: