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Nigel's surgery 88: Sepsis in general practice

Categories:
  • Organisations we regulate,
  • GP and GP out-of-hours services

Individual GPs and even whole practices providing in-hours services are not likely to encounter sepsis frequently but early detection is vital.

Sepsis is a term used to describe the body’s abnormal response to infection. It can affect anyone but is more common in people who have a weakened immune system, a long term condition, are very young or are frail. It can be catastrophic if undetected and untreated; leading to multi-organ damage and an estimated 44,000 related deaths each year in the UK.

Practices must be aware of sepsis and be able to demonstrate how an acutely unwell or deteriorating patient is managed before and during an appointment, including any ongoing referral or care.

Symptoms

Symptoms of sepsis for babies and young children may include:

  • abnormal temperature
  • difficulty breathing
  • lack of interest in eating and drinking, or have stopped feeding
  • not passing urine for 12 hours or longer
  • repeated vomiting
  • unresponsiveness
  • irritability
  • mottled pale or bluish skin, or a rash that does not fade when pressed

Symptoms for adults and older children may include:

  • feeling extremely unwell
  • abnormal temperature
  • chills and shivering
  • a fast heartbeat
  • fast breathing
  • feeling dizzy or faint
  • decreased urine production
  • a change in mental state, such as confusion or disorientation

Early identification of sepsis

The 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report Just Say Sepsis highlights the importance of accurate early assessment and recording and sharing clinical findings.

If sepsis is considered a significant possibility in a remote consultation it is reasonable to consider prioritising urgent admission to hospital. Providing high flow oxygen has been shown to improve outcomes.

The Royal College of Physicians has developed the National Early Warning Score (NEWS) - a standardised approach to assessing acutely unwell patients.

What we expect to see

GP practices should take measures to help manage the risks associated with sepsis. We may consider these as part of our inspections under key lines of enquiry (KLOE):

Examples of good practice include:

  • conducting staff training in recognising and responding to acutely unwell or deteriorating patients who may have sepsis
  • having triage processes which are designed to include the identification of, and rapid response to, possible cases of sepsis
  • having access to appropriate equipment to assess patients with possible sepsis, for example to measure blood pressure, temperature and pulse oximetry for adults and children (see Nigel's Surgery 1: Agreed principles for defibrillators, oxygen and oximeters)
  • achieving high coverage of influenza vaccination, particularly in the over 65s, pregnant women, and those with long-term conditions
  • providing information and guidance on sepsis for higher-risk patients and their carers, for example those with long-term conditions and those prescribed immunosuppressive drugs
  • using appropriate sepsis clinical screening, assessment and audit tools
  • recording and sharing accurate information about a patient’s condition
  • discussing sepsis management at practice meetings
  • having an effective approach to hand hygiene to help reduce the spread of infection.
Last updated:
3 October 2018

 


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