Sepsis in older people – NEWS2 and the NHS Long Term Plan

Beverley Marriott is a Frailty and Dementia Matron working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

Every trust must take action to identify and treat Sepsis, which costs 37,000 lives per year. Sepsis occurs when the body responds poorly to a bacterial infection, attacking its own tissues and organs, and while early treatment is effective, the condition is hard to identify.

Guidance by NHS England which has been drawn up with the Royal College of Physicians, NICE, the Royal College of GPs, and the UK Sepsis Trust, highlights that it is everyone’s business to look for sepsis, even at the very early stages, in patients in A&E, wards and community settings.

Clinical staff should seek advice if they suspect sepsis and refer for urgent medical treatment, and all clinicians should take note of non-specific concerns that have been raised by carers and relatives such as acute changes in behaviour.

From 1 April a change to the NHS standard contract required all NHS trusts in England to comply with guidance on sepsis, written alongside the Royal College of Physicians, the Royal College of GPs, NICE, Health Education England, the UK Sepsis Trust and Patient Safety Collaboratives.

The NHS Long Term Plan includes a new measure for patients with the most serious illnesses and injuries, like sepsis, to ensure that they receive the best possible care in the shortest possible timeframe. The NHS is working with partners to roll out National Early Warning Scores (NEWS2) in acute, community and ambulance settings.

Birmingham Community Health Foundation Trust is working to support the NHS Long Term Plan to transform NHS care by improving how we identify and tackle sepsis.

A large number of people who receive services from Birmingham Community Foundation Trust are over 75, many of whom have dementia and living with frailty. These people are at high risk of sepsis and detecting suspected sepsis difficult, as signs of developing infection may be subtle and atypical. This is especially true in people with dementia, for example, changes in cognitive function may present as changes in behaviour or irritability and as acute changes in functional abilities. Furthermore, early warning errors, incomplete recording of vital signs, data misinterpretation, and staff delays in calling for help and communicating their findings to other healthcare professionals can all contribute to adverse events.

The NEWS2 is a tool developed by the Royal College of Physicians which identifies acutely ill adult patients and can be used to prompt a senior clinical review to judge whether the patient’s illness is due to sepsis.

NEWS2 is a simple but incredibly useful tool to help identify patients at risk of clinical deterioration due to sepsis and is helping to transform the speed and effectiveness of treatment for these patients across the NHS.

Birmingham Community Healthcare Foundation Trust welcomes plans to roll out NEWS2 to help identify sepsis at the earliest possible stage and save lives.