NHS England hospitals told to spot dying patients sooner

This article was taken from: https://www.theguardian.com/society/2018/apr/26/nhs-england-patient-safety-alert-sepsis

By Denis Campbell Health policy editor

Patient safety alert issued after 100 people died in 2017 when their failing health was not recognised

Hospitals and ambulance services have been told to get better at identifying patients at risk of dying after 100 people died last year when their failing health was not recognised.

NHS Improvement has issued a patient safety alert telling England’s 134 acute hospital trusts and 10 ambulance services to do more to spot signs of a patient’s deterioration.

The agency, which oversees NHS patient safety standards, hopes that its move will lead to lives being saved through people receiving faster treatment, because staff will have recognised how close they are to death.

NHSI has acted after the 100 fatalities revealed flaws in the identification of illnesses including sepsis, the blood-borne infection that kills an estimated 37,000 people a year.

Sepsis is challenging for health professionals to identify because its symptoms are also signs of other illnesses. Symptoms in older children and adults include a high or low temperature, a chill and shivering, a fast heartbeat and rapid breathing. Some cases can turn into septic shock, which is characterised by dangerously low blood pressure. In children the signs of sepsis include lethargy, looking mottled, bluish or pale, a rash and fast breathing, according to NHS Choices.

“Too many people are dying unnecessarily from treatable conditions such as sepsis,” said Dr Celia Ingham Clark, NHSI’s interim national director of patient safety.

NHSI has decided to compel every hospital to adopt an updated version of the national early warning score (News) system, which helps staff identify signs of deterioration. These include changes to a patient’s systolic blood pressure or pulse rate, an inability to pass urine or the onset of confusion or delirium.

It says: “In 2017 the national reporting and learning system received 100 reports where deterioration may not have been recognised or acted on and the patient died. Although these patients may not have survived even with prompt action, the care provided did not give them the best possible chance of survival.”

A third of NHS care providers use versions of the News system, which has been overhauled to reduce avoidable deaths from sepsis and other life-threatening conditions. But NHSI has ordered all trusts to implement in full the updated News system – called News2 – by March 2019.

The alert explains that: “Harm could result from having different scoring systems in use across the NHS when patients or staff move between services. The adoption of News2 is vital to standardise how adult patients who are acutely deteriorating are identified and responded to, and to streamline communication across the NHS.”

Peter Walsh, the chief executive of patient safety charity Action Against Medical Accidents, welcomed NHSI’s alert. He said: “It is unacceptable to have different approaches to identifying and treating sepsis in different NHS hospitals. This alert should ensure a more robust and consistent approach, which will save lives.

“We are seeing too many cases of avoidable death from sepsis due to doctors and nurses not monitoring patients well enough, not recognising the early signs of sepsis and intervening.

“Different hospitals around the country are adopting different strategies around sepsis, causing a kind of postcode lottery. By creating one single robust approach nationwide we would be reducing the risk of staff not following the right procedure and patients dying as a result.”

Ron Daniels, the chief executive of the UK Sepsis Trust, said that the NHS-wide take-up of the revised system would help reduce the death toll from the infection.

Caroline Dinenage, the care minister at the Department of Health and Social Care, said: “Sepsis can be a killer and we know from some of the tragic cases of sepsis brought into the spotlight that the signs and symptoms can easily be mistaken for other conditions. This system will better spot the crucial early warning signs and treat patients as soon as possible.

Jeremy Hunt, the health and social care secretary, has made better identification of sepsis a key element of his drive, since the Mid-Staffs hospital care scandal of 2005-09, to improve patient safety across the NHS.