Lessons to be learned from sepsis deaths, says Jeremy Hunt
Health Secretary Jeremy Hunt says that the NHS will learn lessons from missed opportunities to diagnose sepsis, which has led to the tragic deaths of a number of young children.
Jeremy Hunt told MPs in the House of Commons that, while any health service will inevitably encounter some degree of tragedy, issues identified in one case in particular has “significant implications for the rest of the NHS that I’m determined we should learn from”. Other high-profile cases of young children dying because of missed diagnoses have made for harrowing news in the past few days, with parents coming forward with their stories, desperate for lessons to be learned from the tragedies they have endured.
The NHS 111 service, whose call handlers are not medically trained and use a diagnostic software algorithm to offer advice, has also faced criticism after failing to spot serious warning signs in a number of cases. Back in 2013, a survey of GPs revealed that only 11% had confidence in the 111 service, with those who did not citing their main cause for concern as the lack of medically trained call handlers.
NHS England says there were around 123,000 cases of sepsis in England in 2014, 37,000 of which proved fatal, but other sources say the actual figure may be much higher.
Sepsis mistaken for flu?
Difficult to diagnose in many cases, the early symptoms can be mistaken for flu or a viral infection, for which antibiotics are not prescribed. In addition, new advice given to GPs regarding antibiotic stewardship - when antibiotics are only prescribed where absolutely necessary – means that in some cases, a relatively minor infection which the immune system is usually able to shake off may develop into life-threatening sepsis in some individuals.
Early Sepsis treatment crucial
With sepsis, early treatment with antibiotics is crucial to prevent the condition escalating to severe sepsis - when organs begin to show signs of dysfunction - and septic shock, when multiple organ failure has already begun. In addition, symptoms can vary from person to person, which can lead to delays in diagnosis, sometimes until the condition has progressed to its final stages.
UK Sepsis Trust
The UK Sepsis Trust, founded in 2012 by medical professionals, aims to save lives by bringing the issue to the attention of government, raising awareness of sepsis via educating other health professionals and the public and also supporting survivors and the bereaved. As a result of its work with sepsis survivors, the charity has identified the six most common warning signs of sepsis in adults:
- Confusion or altered mental state, slurred speech
- Extreme shivering and muscle pain
- Passing no urine
- Feeling that you may be dying
- Mottled or discoloured skin
- Blood pressure may be abnormally low
The above signs may be indicators that the organs are not receiving enough oxygen, therefore experts urge those who suspect sepsis not to wait for these red flags to appear and to seek medical attention immediately. Other signs include a high temperature, or a low temperature which may indicate severe sepsis.
Symptoms of sepsis in babies and young children
In babies and young children, a range of symptoms can appear differently and may include cold hands and feet with a blue tinge, sleepiness or not responding to carers, rapid, noisy breathing, diarrhoea and vomiting.
A recent review, carried out by the National Confidential Enquiry Into Patient Outcome and Death (NCEPOD), revealed there are around 200,000 cases of sepsis in the UK every year, leading to as many as 60,000 deaths.
Difficult to diagnose, the review found that 36% of sepsis cases were subject to a delayed diagnosis, 52% of severe sepsis cases were not diagnosed straight away and 33% of cases of septic shock were not spotted swiftly. In addition, investigations, such as blood tests and other tests considered essential in accurate diagnosis, were missed in 39% of patients later found to have sepsis.
The report made a number of recommendations, including the use of an early warning score throughout both primary and secondary care settings as well as a full set of vital signs, such as temperature, blood pressure, heart rate and respiration rate, be taken upon arrival at A&E departments and at regular intervals.
What is sepsis?
Sepsis is defined as an overwhelming response to infection, whereby the immune system mounts an inflammatory reaction which can eventually lead to organ dysfunction and failure. It can be difficult to diagnose but can be successfully treated with antibiotics if it is spotted in its early stages.
It can begin with a small wound or injury, resulting in an infection, or following an illness, such as a bladder or lung infection. If untreated, an infection can begin to overwhelm the body and a patient may go on to develop sepsis - a clinical emergency.
Who is susceptible to sepsis?
While anyone can develop sepsis, it is more common in babies and young children, in elderly people and in people with immunosuppression. Pregnant women up to six week’s post-partum and people who have recently had surgery, or have had an intravenous line or catheter, are also slightly more at risk of developing sepsis.
Sepsis can develop rapidly, particularly in the very young or old, so if you suspect a series of events may have developed into sepsis it is vital that you seek urgent medical attention, taking care to outline all of the symptoms that you or your loved one is experiencing. Write down what has been happening in a consecutive order and take it with you.
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