NHS Shetland Progress with Sepsis Six Dr Brodyn Poulton Consultant - PowerPoint PPT Presentation

NHS Shetland Progress with Sepsis Six Dr Brodyn Poulton Consultant Anaesthetist April 2013

Overview • Patients who trigger for Sepsis in the Surgical team are reviewed at the monthly audit meetings. • Exceptions and learning points are agreed and actioned. • Completed surgical case reviews are presented here (two still to complete from last month) to discuss common problems re inclusion criteria.

Case 1 • 83 year old male, developed chest infection after surgical repair of #NOF. • All measures taken, other than specifically documenting SIRS. • Abx: Guideline compliant, given within the hour.

Case 2 • 72 year old male with acute cholecystitis. • No blood cultures, U&E taken, SIRS/Sepsis not documented. • Amoxicillin given within the hour. • Gentamicin given at five hours, 600 mg. Given in spite of no U&E and steadily worsening oliguria. Developed ARF, requiring haemofiltration.

Case 3 • 46 year old male, presumed submandibular abscess. • All measures taken, except specifically documenting SIRS/Sepsis in the notes. • Correct Abx, given within the hour.

Case 4 • 25 year old male, ulcerative colitis, colectomy. • 27/2/2013 – Readmitted. Technically met criteria for Sepsis / MEWS 4. • Temp 38 C. However, CRP minimally elevated, and WCC in normal range. • Impression: overactive stoma and dehydration. • Managed appropriately, no antibiotics.

Case 5 • 88 year old female, spiked temp 38 C post surgical repair of #NOF. • Technically had SIRS and MEWS 4. • However, 2 MEWS points for SaO2 consistent with age! • Clinical impression: chest infection. • Started on appropriate Abx.

Case 6 • 66 year old male. Syringomyelia, wheelchair bound since 1991. • Presented with Severe Sepsis, MEWS 6. • All measures taken, including documenting “Sepsis Six”. • Tazocin, changed to Cotrimoxazole.

Summary Data table Date Patient sequence Compliance % Compliance with number Sepsis six bundle 06/01/13 1 6/6 100 03/02/13 2 5/6 83 09/02/13 3 4/6 67 27/02/13 4 4/5 80 14/03/13 5 4/6 67 16/03/13 6 6/6 100 25/03/13 7 6/6 100 25/03/13 8 6/6 100

Summary data chart % Compliance with Sepsis six bundle 100 90 80 70 60 50 % Compliance 40 30 20 10 0 1 2 3 4 5 6 7 8

Next actions • Get next progress update from the medical team • Implement lactate measurement – software upgrade needed to do this underway. • Continue to promote principles of Sepsis Six • Continue to monitor compliance.