Sepsis Toolkit

Sepsis is a rare life threatening condition that can develop rapidly from what might be otherwise innocuous infections. Recognising it at an early stage among the huge number of ordinary infections can be a challenge even to experienced clinicians.

Sepsis affected 123,000 people in England in 2014, resulting in approximately 37,000 deaths. 70% of cases derived from an infection developed in the community. It is estimated that there is potential to reduce deaths by up to 10,000 per annum by the optimisation of care 

The Sepsis toolkit provides a collection of tools, knowledge, and current guidance to support the identifying and appropriate management of patients with sepsis. The toolkit is aimed at GPs and healthcare professionals assessing people in the community with acute infection. The resources also include information for patients and those close to them to look for when concerned about a sudden deterioration in a person’s health in the presence of infection.

Clinical resources and guidance for practices

The Sepsis Trust has created a range of resources to support clinicians in delivering the NICE guidelines. Similarly, GP clinical systems are being equipped to support clinicians by including the physiological values considered abnormal in the NICE Sepsis Guidelines.

NICE Guidance

CKS

Further Guidance

Sepsis Trust decision support tools

The following resources are based upon the NICE Sepsis Guidance CG51

Top Tips for GPs and primary healthcare professionals

The top tips list was produced by participants at the RCGP Sepsis London workshop in November 2016.

Background information

National Early Warning Scoring system. Suggested by NCEPOD Report and others for potential use in General Practice, this has the value of providing a baseline recording of physiological variables and communicating risk and concern to secondary care colleague regarding sick adults. Its use as a screening tool in Primary Care is not established.

A Free NEWS 2 calculator can be downloaded on apple and android, which can consider hypercapnia both on and off supplemental oxygen 

GP Clinical Systems

It is noted that all GP clinical systems have aide memoire and templates for the recording of physiology useful in the documentation patients who are unwell with infection. Although there has been no formal college input to the construction of these it is advised that clinicians consider use them. Their use is important not only in documenting the severely unwell with sepsis but also when recording when the signs of sepsis were absent, and that appropriate safety netting has been given.

Ultimately it is hoped that these systems will also support the production of early warning scores, admission leaflets and patient / parent advice leaflets.

Quality Improvement

To access shared learning networks to assist you in applying practical QI methodologies to better treat this clinical area, join our QI Ready platform.

National reports and legislation

Below are some of the most significant national reports and documents relating to sepsis.

Significant national reports

International Definitions and NICE Guidance

Strategic Guidance

Resources for patients and carers

Recognising Sepsis

This is a challenge for trained clinicians as the signs and symptoms can be varied and subtle at the onset of sepsis. Patients, parents and carers often ask what they should look out for.

Patients

Treating your infection without antibiotics Leaflets (with Safety netting advice) - Full range of leaflets in multiple languages can be found at the Target Antibiotic toolkit under leaflets to share with your patients.

Parents 

Mobile Apps 

Charitable Organisations 

Meningitis Charities

Resources for training and appraisal

Sepsis care and identification has been a focus of much attention with new definitions and guidelines. It is important that clinicians keep up to date.

Guidance for GPs:

At the national summit for the sepsis clinical priority in November 2018, we launched the booklet: Sepsis: Guidance for GPs, written by the RCGP Sepsis Clinical Priority team with support from Health Education England. It gives information on sepsis epidemiology, top tips for sepsis aware consultations and Sepsis leads, and clinical scenarios. The booklet is aimed to be used alongside e-learning and presentations to share sepsis learning across practices. The guidance booklet will be developed into a Train the Trainer PowerPoint presentation pack, allowing GPs to carry out workshops locally based on the findings and formats of the regional workshops undertaken by the sepsis clinical priority project over the last four years. 

Education

There are scheduled events hosted by regional faculties, which feature sepsis treatment.  

E- learning

Presentations

The following presentations were just some used during the series of regional Sepsis workshops 

Two significant cases among many: Sam Morrish and William Mead

RCGP National Conference 2017 -  Sepsis vs Antimicrobial resistance: A Tightrope for GPs to Tread. A joint presentation between the Sepsis and Antimicrobial leads describing the challenges in delivering a sepsis and antibiotic stewardship aware infection consultation

Pre-Hospital Recognition of Sepsis: Why is booking an ambulance such a pain?

Practice Resources

Reception Staff Training. This package from Hartlepool & Stockton Health GP Federation has been developed to assist practices in reception staff training in identifying areas of concern when taking calls from patients. It covers Chest Pain, Stroke symptoms (FAST), Breathlessness and Sepsis. It is ideally delivered by a trained practice lead for sepsis.

Podcasts 

Building Sepsis Aware Communities

Just Say Sepsis! Sepsis, Physiology and Communication

Suspect Sepsis? Communicating with Ambulance Services

 

 

Webinar

Background and information for commissioners

 
The RCGP is currently working with Health Education England, NHS England and others to try and identify the areas of sepsis care which need to be in place to operationalise the recent guidance and strategic planning to create a uniform pathway for the recognition, diagnosis and definitive treatment of sepsis.

Sepsis Summit, Liverpool, 27 November 2018 - reflections

On 27 November 2018, over 100 GPs gathered in Anfield stadium, Liverpool, for the third national summit for the RCGP Clinical Priority project for Sepsis. The summit was an opportunity to not only raise awareness of sepsis amongst GPs, but to also highlight work taking place across the country aimed at improving detection and patient outcomes. The day also saw the launch of a guidance booklet produced by the RCGP Sepsis Clinical Priority team in partnership with Health Education England. 

The packed agenda started with a rousing keynote speech from the College Chair, Professor Helen Stokes-Lampard, about the future of our profession, discussing the progress towards the goals set by GP Forward View, as well as the need for task substitution - not role substitution - within the future GP team. 

Bristol GP and member of the south west Academic Health Science Network, Dr Alison Tavare, shared her own emotional experience of sepsis, as well as her team’s award-winning work with NEWS2 (National Early Warning Signs). 

The morning concluded with a presentation from North West Ambulances’ Medical Director - David Ratcliffe. David, also a GP, who discussed the challenges that sepsis poses to both GPs and the ambulances services alike, and how the ambulance service is working to ensure GPs and their patients get the optimum response from ambulance teams. 

The afternoon saw presentations from Out of Hours teams, as well as teams from the Nursing Home sector and Interserve, a provider of in-home care to several hundred patients. The presentations highlighted the challenges that GPs face around sepsis in these environments, and a question and answer session included points about patient autonomy, clinical judgement and the role of physiology in sepsis detection. All present agreed the need for ongoing research in these areas. 

The day ended with the RCGP and Health Education England Clinical Champion for Sepsis, Dr Simon Stockley, giving a presentation on emerging themes in sepsis, such as technological challenges, the role of other GP staff such as receptionists, and human factors in sepsis cases. 

Each delegate left with a hard copy of the booklet Sepsis: Guidance for GPs, written by the RCGP Sepsis Clinical Priority team with support from Health Education England. It gives information on sepsis epidemiology, top tips for sepsis aware consultations and Sepsis leads, and clinical scenarios. The booklet is aimed to be used alongside e-learning and presentations to share sepsis learning across practices. The guidance booklet will be developed into a Train the Trainer PowerPoint presentation pack, allowing GPs to carry out workshops locally based on the findings and formats of the regional workshops undertaken by the sepsis clinical priority project over the last four years.

Links to presentations:

RCGP / HEE Sepsis Summit Introduction 

The West of England AHSN: Spreading the NEWS: Dr Alison Tavaré

The Deteriorating Patient Interacting with NWAS: Dr David Ratcliffe 

Emerging Themes and Challenges in Sepsis: Dr Simon Stockley

Improving Sepsis Management Using NEWS in Out of Hours Primary Care: Dr John Caldwell and Dr Suzanne Fletcher

 

Please send any comments or suggestions to circ@rcgp.org.uk. Any agreed updates will be made on a routine basis, unless immediately necessary for factual reasons.

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