Sepsis

Selected Guideline Examples Date
Dartford and Gravesham
August 2019
Mid Yorkshire Hospital
December 2019
North Bristol NHS Trust
September 2019
University Hospital Coventry
July 2020
What we liked
  • Identification of high risk patients eg. multiple attenders to hospital, women who work with children (Strep A), recent (within 2/52) treatment with antibiotics
  • Highlighting MBRRACE recommendations including use of imaging if necessary, despite pregnancy, multidisciplinary team approachTimely recognition
  • Differentiation between signs of sepsis in obstetric/non-obstetric patients
  • Use of critical care outreach
  • Indications for transfer to ICU
  • Treatment algorithms and patient stickers (Bristol)
  • Clear instructions including antibiotic regimens for local units
What we didn't like
  • Use of birthing pools for delivery in women with suspected sepsis mentioned in one guideline
Other comments
  • The qSOFA (quick sequential organ failure assessment) score is mentioned in some guidelines with some emphasis being placed on this for subsequent management. This has been used to identify patients outside the ICU with suspected infection that are at high risk of in-hospital mortality. However, it is now recognised that a modified score is appropriate for pregnancy - the qSOFA-P. Altered mental state (GCS<15), SBP < 85mmHg, and RR >/= 35 bpm were better predictors of adverse outcome in pregnancy compared with the traditional values in the non-obstetric population (AMS, SBP<100mmHg, RR>22bpm).
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