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GPs urged to start antibiotics for sepsis ‘within an hour’

GPs must make sure patients with suspected sepsis are started on antibiotics within an hour of being assessed, starting treatment in their surgery if the patient will not make it to hospital in time, NICE experts have said.

The latest NICE advice – part of a set of proposed quality measures on sepsis – also says GPs should make sure they carry out a structured risk assessment in any patient they suspect of sepsis, recording vital signs such as temperature and heart rate and checking for rashes and skin discolouration.

And even if someone is judged low risk, GPs should give them safety-netting information so they know what to look out for if their symptoms should worsen, NICE said.

The recommendations are set out in new draft metrics that NICE says the NHS should adopt to monitor sepsis care, following the release of guidelines on it last year.

They are principally aimed at secondary care, stating that anyone with suspected sepsis in acute hospital settings must be assessed within an hour by a clinician – and have antibiotics started straight away if sepsis is diagnosed.

But NICE also stressed that ‘if it will take more than an hour to get to hospital, antibiotics can be given in GP practices or by ambulance staff’.

The standards state that people with suspected sepsis should be ‘assessed to stratify risk of severe illness or death using a structured set of observations’.

In addition where a GP has gone through a risk assessment and judged a patient to be low risk, they should provide them ‘information about symptoms to monitor and how to access medical care’.

It comes after a 2015 report by the National Confidential Enquiry into Patient Outcome and Death found that 40% of people admitted to A&E with sepsis did not have a timely review by a senior clinician, while there were avoidable delays in administering antibiotics in three out of every ten cases.

Professor Gillian Leng, NICE deputy chief executive, said: ’Severe symptoms can develop in sepsis very quickly. If high-risk patients are not identified and treated promptly, people can be left with debilitating problems. In the worst cases, they may die.

’This quality standard highlights priorities in the continued fight to improve sepsis care. We know from recent case reviews that there are inconsistencies in how people’s symptoms are assessed in different settings. More can be done to provide rapid treatment.’

Health Secretary Jeremy Hunt said: ’Every death from sepsis is a tragedy, yet too often the warning signs are missed - we need to get far better at spotting sepsis across the NHS and this advice shows how vital it is for clinicians to treat life-threatening symptoms as soon as possible.

’Our relentless drive to raise awareness of this deadly condition, as well as the tireless efforts of campaigners and families who have lost loved ones, has seen a million leaflets and posters already distributed to GP clinics, hospitals and other public places - helping raise awareness to fight against this devastating condition.;

The quality standard is currently in consultation and GPs have until 7 April to comment on the proposed measures.

NICE sepsis quality metrics - in full

People with suspected sepsis are assessed to stratify risk of severe illness or death using a structured set of observations.

People with suspected sepsis in acute hospital settings and at least 1 criteria indicating high risk of severe illness or death are reviewed by a senior clinical decision-maker within 1 hour of risk being identified.

People with suspected sepsis in acute hospital settings and at least 1 criteria indicating high risk of severe illness or death have antibiotic treatment within 1 hour of risk being identified.

People with suspected sepsis in acute hospital settings, at least 1 criteria indicating high risk of severe illness or death, and with lactate over 2 mmol/litre, have an intravenous fluid bolus within 1 hour of risk being identified.

People who have been seen by a healthcare professional and assessed as at low risk of sepsis are given information about symptoms to monitor and how to access medical care.

Source: NICE

 

 

Readers' comments (21)

  • if i suspect significant sepsis,ie systemically unwell they go straight to A+E. Its not my job to buffer the inadequacies of other systems eg ambulance service waits or the 4 hr A+E wait. Its these things that need addressing not GP services if you want more prompt treatment of sepsis. The main role of general practice is the recognition of the problem, not treatment which is secondary care based.

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  • Hello NICE
    Why don't you get stuck into that hapless Hunt about the resources that are needed for this.
    What we need like a hole in the head are guidelines that can't be met, which suffice only to satisfy solicitors.
    Any comments about your precious NICE Dr Haslam???:

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  • there are a lot of people talking about this issue at present. I see no-one advising the public that in the early stages of sepsis it is impossible to diagnose. This needs to be a major part of the education programme.
    This is a great example of the disconnect between politicians and nhs "leaders" who are actually hurting the front line with their misplaced good intentions.

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  • Give antibiotics to everyone with a temperature and who is unwell in an hour they might have sepsis?We are going to need a lot more new antibiotics ,whoops non coming!More resilience and colouring books need RCGP.

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  • This sepsis campaign is becoming a serious issue for GPs and I'm not sure what can be done about it. Mr Hunts claim that "often the warning signs are missed - we need to get far better at spotting sepsis across the NHS" is based on retrospectoscopic analysis. As mentioned above, it can be difficult to detect in the early stages and we see huge numbers of people who are quite unwell with borderline obs the vast majority of whom do not need admitting. All this is doing is driving a culture of anxiety, over-investigation, excessive antibiotic use and massively increasing legal risks for doctors should anyone get sicker as time passes. A doctor has already been convicted in 2015 for 'missed sepsis'. NICE need taking to task for jumping on this bandwagon - it's time for an urgent rethink based on real world practice, not impossible to reach ideals.

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  • what is funny is seeing non scientists (NHSE) types talk about need to reduce antibiotic use and then immediately after talk about need to treat sepsis early and with lower thresholds !

    The gulf between those who are scientifically educated and not is so vast you would not believe.

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  • Spuds

    If Jezza is so worried about mortality figures he should resign and let someone competent run the NHS in England.

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  • Neo99 totally agree with you.
    Glad old Jeremy thinks it's so easy to diagnose.

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  • *

    Fascinating that J Hunt should give such a long winded comment on a set of clinical guidelines as the health service falls apart and NI GPs walk for the door ( not in any national newspapers weirdly) He seemingly doesn't see himself as a politician, who's job it is to ensure the health service runs adequately at the 'macro' level, he apparently regards himself as a quasi-physician here to monitor and guide clinical practice. What a total jacka@&

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  • It will be the locums and salaried who cop the flack as partners don't seem to see many acutes.

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