21st Oct, 2020

Sepsis Nursing Interventions in a New Age of Technology

Sepsis can be fatal if not spotted early, and nursing interventions are key to noticing the symptoms on time. Recent technological integrations have shown promise in facilitating nurses' management of sepsis patients, yet the UK still seems to be struggling to keep up with other wealthy nations when it comes to hindering the number of deaths caused by sepsis. Here we unpack the latest research...

   

Sepsis can be fatal if not spotted early, and nursing interventions are key to noticing the symptoms on time. More common than heart attacks, sepsis is one of the leading causes of death in the UK so finding new ways to prevent the infection will give patients better clinical outcomes. 

According to recent studies, sepsis accounted for approximately 20% of all global deaths in 2017. That may not seem like a large number but, with around 240,000 cases and 52,000 deaths each year in England currently, blood poisoning now claims more lives than lung cancer - the third biggest killer after heart disease and dementia

The UK has invested a lot of resources into tackling sepsis, with some recent digital interventions showing real promise. However, when you compare our efforts to that of other countries, it seems we need to do more. 

    

We unpack the latest research and interrogate:

 

Estimating the burden of sepsis


On top of the massive social impact, York Health Economics Consortium (YHEC) estimated that sepsis costs the NHS between £1.5 and £2 billion each year and the wider economy up to £15.6 billion. 

Sepsis Nursing Interventions - costs the NHS

     

Up until recently, there was no sign of improvement. Published in their latest report, The Sepsis Manual (5th edition), the UK Sepsis Trust have demonstrated the incidence of sepsis rising by approximately 11.5% each year in England. 

   

Sepsis nursing interventions - sepsis incidence in England
Sepsis incidence in England (no. of episodes per year), source: NHS Digital

   

Is the UK failing to keep up with economically comparable nations’ progress on cutting sepsis mortality?
 


As with most health-related issues, significant socio-economic disparities in sepsis incidence and mortality exist internationally. However, more surprising is the fact that these disparities still exist amongst wealthy countries, with sepsis death rates in Britain five times higher than the best-performing countries in Europe: Finland, Iceland and Ireland.

 

So what exactly is sepsis?


Sepsis and septic shock refers to the body's extreme response to infection, such as pneumonia, influenza, or urinary tract infections.In the past, sepsis has been referred to as septicaemia or blood poisoning, but they both actually describe the bacteria present in the blood, which in turn can cause sepsis. 

When the body is fighting infection, the white blood cells that attack bacteria, viruses, parasites, or fungi, can turn on the good cells of the body. This produces a systemic inflammatory response, which, in minor cases where there is no sign or organ failure, has about a 15%-30% chance of death but in severe cases, the mortality rate rises to between 40 and 60 per cent. 

Those that do survive sepsis are often left with a variety of physical and psychological problems that can be life-changing. This is often referred to as Post-Sepsis Syndrome, widely characterised by everything from disordered sleeping, to low self-esteem to extreme health problems such as organ dysfunction and limbs having to be amputated.  

The reasons our immune systems react in this way is unknown. What we do know is that people who are more likely to get an infection – the elderly, young children, and immunosuppressed people - those with a suppressed or compromised immune system - are more likely to get sepsis.


Sepsis risk factors: 

  • Age 75+
  • Impaired immunity (e.g. due to diabetes, steroids, chemotherapy)
  • Recent trauma, surgery, or invasive procedure
  • Indwelling lines, IVDU, or broken skin

 

How is sepsis currently diagnosed?


Early stages of sepsis can look very much like the flu. Thus, difficulties in differentiating sepsis from other conditions like the flu have historically led to it being misdiagnosed and mistreated. 

Severe sepsis is a leading cause of death for critically ill children of whom are treated in a pediatric intensive care unit. In 2017, for instance, almost half of all global sepsis cases occurred among children. 

Here are the signs and symptoms that nurses and other clinicians should be looking out for across age groups:

     

Sepsis in young children and babies

  • Skin, lips, or tongue that’s blue or pale, and blotchy skin
  • A meningitis-type rash that doesn’t fade when you roll a glass over it
  • Breathing difficulties, breathlessness, or fast breathing – you may recognise a grunting noise or their stomach being sucked in
  • A high-pitched, weak cry that’s different to normal
  • Not as responsive as normal and not interested in food
  • Being very sleepy or hard to wake up


Sepsis in adults and older children

The symptoms of sepsis in adults and older children are roughly similar, such as blue, pale or blotchy skin or lips, the same type of rash as noted above, and breathing difficulties. You may also notice that the patient has a confused mental status, is disorientated, and not making sense when they talk. 

Along with these signs of sepsis, there are other indicators that you should be on the lookout for, like: a general feeling of being unwell; no urine output for 24 hours, or 12 hours in a baby or young child; a wound with redness or swelling around it; either a very high or very low temperature; and specifically in babies, not being able to keep food down due to vomiting. 

 

Determining treatment


Once the general symptoms have been recognised, there are defined medical parameters which would trigger a sepsis treatment. Any two of these indicators are a sign of uncomplicated sepsis:

  • Temperature over 38.3° or under 36°
  • Pulse over 90/min
  • Respiratory rate over 20/min
  • White blood cells over 12 or under 4 per 109/litre
  • Blood glucose over 7.7 mmol/L

Whilst severe sepsis is defined as at least two of these indicators plus one other dysfunctional organ. Sepsis and septic shock would include at least two of these indicators plus shock criteria which are high levels of lactate and low blood pressure.

NEWS2 was introduced by the Royal College of Physicians (RCP) in 2017. NEWS2 is an iteration of the original NEWS, which has become the most evidence-based track-and-trigger scoring system globally. These standardised clinical charts are there to help clinicians use all the information at hand to be able to diagnose and treat sepsis along with other acute illnesses.

 

The importance of early intervention


With the prevalence of sepsis being so high, there is a focus on spotting the problem early. Studies show that the earlier IV antibiotics are administered, the better the chances of recovery. Indeed, for every hour delayed, the chances of recovery drop by 4 per cent.

In the UK, there have been significant efforts to drive down sepsis and septic shock rates in recent years - particularly after some high-profile cases of the condition, such as William Mead, who died of sepsis at just 12 months old in December 2014 following a string of NHS blunders.

By using the data gathered from previous cases, there have been clear indicators outlined to diagnose sepsis early and intervene in a timely manner. A recently proven system implemented in St Mary’s, Charing Cross, and Hammersmith hospitals has proven that early nursing interventions in line with recommended nursing care plans for sepsis can improve outcomes and survival rates for patients with sepsis.

 

How are sepsis interventions changing with technology?


Technological advances and digital interventions have shown promise in informing nursing interventions for sepsis. 

One new piece of technology that has recently been shown to lead to fewer deaths and shorter hospital stays is a digital alert system that measures the vital signs of patients (such as temperature, heart rate and glucose levels) whilst notifying a nurse to potential cases of sepsis. 

Tested across three Imperial College London hospitals, researchers found patients who had triggered the alert system were 24% less likely to die and 35% more likely to receive intravenous, broad-spectrum antibiotics within the recommended one hour.

The study is the first evaluation of a digital sepsis alert system in a British hospital trust and the largest undertaken anywhere to date. In addition to the alerts, the trust also introduced a multidisciplinary nursing care plan guide that automatically launches in the electronic patient record when a diagnosis of sepsis is confirmed. 

The research team is planning to carry out a larger study involving more NHS hospitals to see whether the results are the same in a bigger patient group and Imperial College Healthcare is set to roll the system out further across the trust.

  

“More patients are surviving sepsis at our hospitals and it is testament to the alert and treatment plans"

Dr Anne Kinderlerer

       

Sepsis patients are often put in ventilators to help them breathe. Researchers at Imperial College London are to trial a device at the Royal Brompton Hospital, in Chelsea, that will aim to reduce the risk to patients on ventilators in intensive care units. The system can stream data in real-time across the UK — enabling experts at the Brompton, one of five specialist respiratory failure centres in the country, to advise doctors in other hospitals.

Finally, data-led diagnosis assessments have also been developed, such as the National Early Warning Score 2 (NEWS2). 

Key data shows that patients who were monitored with the National Early Warning system:

    

  • Had a lower chance of dying compared to a control group
  • Would be more likely to stay in hospital less than seven days
  • Received antibiotics within the first hour of sepsis being recognised

 

Conclusion


Sepsis is costly, both in terms of human lives and the cost to health services when treating it. With a range of symptoms that can easily be misinterpreted, technology is starting to play a vital role in the diagnosis and prompt treatment of sepsis. 

Analysing the data around sepsis, its treatment, and its outcomes have led the RCP to introduce a simple but powerful tool to aid in diagnosis which can prompt on-time treatment. Taking this further, hospitals in the Imperial College London trust trialled a technology-led system that alerts nurses to patients that may potentially have sepsis. 

With strong positive results from the study, the plan is to widen its scope and implement it across more NHS trusts. Further studies are in the pipeline to understand ventilator use in sepsis with remote monitoring capabilities. It’s been proven that tech can bring about higher survival rates and shorter hospital stays, it’s now time to watch the improvements rollout. 

Post last updated on 27/11/2020