NICE experts are urging GPs to record a raft of observations in children and adults with suspected sepsis – including blood pressures and oxygen levels where possible – under draft guidelines aimed at speeding up recognition and treatment of the condition.
The guidance – the first NICE has done on sepsis – says GPs should ‘use a structured set of observations’, such as heart and respiratory rates, as well as blood pressure and oxygen levels, when assessing people who they suspect might have sepsis.
They should then work out the person’s risk of severe illness or death, using the observations combined with a history and physical exam, to help decide whether an urgent referral is needed.
The new draft guidelines form part of NHS England’s new drive to cut avoidable deaths from sepsis, which also includes plans to offer GPs an education module.
NICE said they should help ‘healthcare professionals… recognise sepsis so they can provide early treatment’.
The recommendations on taking observations state that GPs should assess ‘temperature, heart rate, respiratory rate, systolic blood pressure, level of consciousness and oxygen saturation’ in young people and adults.
Instead of blood pressure, they should measure capillary refill time in children under 12 and take blood pressure only in those under five, ‘if heart rate of capillary refill time is abnormal’.
However, the guidelines add that GPs should only measure oxygen saturation, and blood pressure in children, if the appropriate equipment is available ‘and taking a measurement does not cause a delay in assessment or treatment’.
GP leaders welcomed the new guidelines, but warned NICE should make it clearer that GPs should not waste time on observations – particularly measuring blood pressures or oxygen saturations – if it could hold up a referral.
Dr John Cosgrove, RCGP council member and a GP in Birmingham, commented: ‘Overall I welcome the guidelines but there are a few caveats that are at danger of being missed. My concern about taking all these observations is – is it really necessary, does it really add anything or is it going to slow down and confuse?’
He added: ‘It could result in more length telephone consultations while you argue about whether you need to take the observations or not. Certainly blood pressure and oxygen sats, I would question if that equipment is routinely available in general practice.
‘I would like to see the caveats about taking these observations made much clearer up front.’
NICE said over 123,000 people in England had sepsis last year and that the condition is thought to kill around 37,000 people every year, while a report from the National Confidential Enquiry into Patient Outcome and Death revealed delays in identifying sepsis in over a third (36%) of cases.