CLINICAL GUIDELINE FOR THE MANAGEMENT OF SEPSIS IN ADULT PATIENTS 1. Aim/Purpose of this Guideline 1.1. This guideline aims to improve outcomes for patients presenting with sepsis or developing sepsis whilst an in patient, by providing evidence based recommendations for practice. It is intended for the use of both medical and nursing staff. 1.2. For children, peri-natal sepsis or neutropaenic sepsis in cancer patients, please refer to the dedicated sepsis guidelines available via the documents library and the guidelines link available on all trust PCs. 2. The Guidance 2.1. Introduction Sepsis is a life threatening condition that arises when the body s response to an infection injures its own tissues and organs. Sepsis leads to shock, multiple organ failure and death especially if not recognized early and treated promptly. Sepsis is estimated to cause the deaths of 37,000 annually in the UK. Early intervention has been shown to save lives and reduce length of hospital stay and the need for Critical Care admission. 2.2. Screening All patients who have a NEWS 5 (amber or red), or any individual NEWS element 3, should be considered for sepsis and the sepsis screening on the reverse of the NEWS chart be completed. Page 1 of 9
2.3. Sepsis 6 / BUFALO The sepsis 6 has been branded with the pneumonic BUFALO in RCHT to enable the easy memory and encourage 100% compliance with the bundle. BUFALO (Blood cultures, Urine output measurement, IV Fluids, Antibiotucs, Lactate measurement, Oxygen) bundle stickers for the patients record are available in all acute admitting areas. For all patients with sepsis the BUFALO bundle should be completed and for those with evidence of severe sepsis or septic shock this must be done within 1 hour of recognition. Below is a copy of the BUFALO sticker and the sepsis alert found on the NEWS chart used for all adult inpatients. Page 2 of 9
The guidance is that senior medical input (consultant/registrar) is requested immediately, Outreach or Critical Care are informed and the BUFALO is completed in under one hour. The patient will then be re-assessed at one hour and this is to be documented on the BUFALO sticker in the clinical record. Page 3 of 9
3. Monitoring compliance and effectiveness Element to be monitored Lead All 6 elements of the Sepsis 6 bundle (BUFALO) to be audited Nominated clinical leads for acute medicine, emergency medicine, surgery, paediatrics Tool Frequency Reporting arrangements Ongoing rolling audit to be prepared on a monthly basis initially With aim for weekly audit Divisional governance meetings Report to the Medical Director and the Trust lead for Sepsis Acting on recommendations and Lead(s) Change in practice and lessons to be shared Trust lead for sepsis Divisional governance meetings Page 4 of 9
4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website. 4.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 5 of 9
Appendix 1. Governance Information Document Title Date Issued/Approved: 13 th July 2015 Date Valid From: 13 Jul 15 Date Valid To: 13 Jul 18 Clinical Guideline for the Management of Sepsis in Adult Patients Directorate / Department responsible (author/owner): Dr M Spivey, Trust Sepsis Lead Contact details: 01872 253147 Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Guideline for the treatment of sepsis utilising the sepsis 6 under the mnemonic Sepsis, sepsis6, BUFALO RCHT PCH CFT KCCG Medical Director New document New document RCHT Sepsis committee Duncan Bliss Not Required {Original Copy Signed} Name: {Original Copy Signed} Internet & Intranet Clinical/ General SepsisTrustUK http://sepsistrust.org/ Intranet Only Page 6 of 9
Related Documents: Training Need Identified? None No Version Control Table Date Version No Summary of Changes Changes Made by (Name and Job Title) 13 Jul 15 V1.0 Initial Issue Dr M Spivey, Trust Sepsis Lead All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 7 of 9
Appendix 2. Initial Equality Impact Assessment Form Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Clinical Guideline for the Management of Sepsis in Adult Patients Directorate and service area: Is this a new or existing Policy? New Anaesthesia & Surgery Name of individual completing Telephone: 253147 assessment: Mike SPIVEY 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups To ensure safe, standardised practice for patients with sepsis, severe sepsis and septic shock 2. Policy Objectives* To provide direction for staff caring for the group 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Patients are treated safely and to a national standard Audit weekly target Patients with sepsis, severe sepsis and septic shock No Page 8 of 9
Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 9 of 9