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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