Why do they always say staff need more training when people (mostly kids) die from sepsis?

[HangerLaneGyratorySystem]

https://www.bbc.co.uk/news/uk-england-bristol-66752180

Surely doctors and nurses etc should be thinking of sepsis at all times?! This excuse is so often trotted out:

Because the symptoms are often dismissed as being due to a milder condition which is treated in isolation, not taken as a risk factor of sepsis prompting further investigation early enough to treat it successfully.

I am a nurse. 7 years now in ED. Sepsis was taught on at uni and had been part of my triage everyday since. Think sepsis. Only one indicator is required to ‘red flag’ and the sepsis bundle is then completed - bloods, cultures, cannula, IV antibiotics, fluids - I’m not sure how sepsis is being missed to the point it’s fatal unless presenting very late and patient is too unwell to recover.
wherever this happened DO need training ASAP. This is heartbreaking 💔

Just looking into this a bit more in detail, a thing that particularly worries me, as does the lack of NEWS training (especially as the N stands for National eg. All UK hospitals should be using and following it) is that apparently Maddy didn't have observations done for 16 hours.

Depending on the ward, patients can have them anywhere from every 4 to every 12 hours usually, and she would have shown signs of deterioration that should have prompted the nursing staff to think about doing a set of obs on her (regardless of when she was next due them) before she got the point that she was so septic that she ended up passing away due to it.

She was apparently NEWSing a 3 on her blood pressure which means a systolic of 90 or less and every one in a hospital, doctor or nurse or other healthcare staff SHOULD know that that requires immediate attention and further investigation/escalation, even if you didn't understand the NEWS, those numbers alone should worry you!

I nearly died of sepsis myself when I was little because doctors missed the signs for several days and it greatly saddens and frustrates me that things like this are still happening in this day and age.

My son died of sepsis at out local hospital. I questioned if it was sepsis and told no. An inquiry took place and revealed that the red flags were there for sepsis (blood markers, temperature, raised heartrate) but all somehow never made it to his paperwork.

That same hospital, 4 and a half years on made the news because of the risk of infection and sepsis being missed.

I don't go to that hospital anymore for my children's care, or for my antenatal care.

Maybe because at night one junior doctor covers 7 / 8 wards , carries a bleep and has been working 10 or more hours without a break.

My hospital had a really good PEWs system. It triggers sepsis alerts and you have to enter a response to get rid of the alert. It automatically escalates to
Medical staff as well. However there is not yet a national PEWs system. And having done agency in other hospitals, I can see how it can be missed as their obs systems are not as good. One hospital doesn't even include temperature in their score. Which is very concerning.

Presumably there are nurses there?! It doesn't sound like this was a staffing problem, it reads like it was a training or procedural issue.

@Kalodi I am so very sorry for your loss.

I'm so very sorry for your loss, @Kalodi . 💐

This story is heartbreaking as is @Kalodi and anyone else who’s lost a loved one from a preventable course.

@Gracemai1 im really interested in your view of what went wrong with Maddy in this story. The symptoms look absolutely Barn door so why didn’t anyone raise the alarm?

I genuinely thought we were beyond the point where we didn’t listen to nurses or juniors, in fact I’m sure most Drs I know value a nurse’s view of a sick patient over and above anything else. What do you think went wrong and what is the first step to preventing it happening again?

The real problem in hospital is a severe lack of highly qualified and experienced staff. Blood pressure / heart rate / respiratory rate checks get done by the most junior members of staff (health care assistants) a lot of the time, the nurses are supposed to keep track of these, and the HCA should flag anything worried but when you're the only qualified on shift who actually knows the ward you end up running around doing all of the stuff the agency staff don't know how to do it's easy to see how obs don't get recorded properly or acted upon in a timely manner.
It's shockingly poor care that clear signs of sepsis are being missed, but it's unsurprising.
The doctors are expected to cover huge numbers of patients and will split their time between A&E, surgery and the wards so if the nurses don't tell them in very strong terms that they need to see the patient urgently they won't get seen for more than 2 minutes a day.
I no longer work on a hospital ward due to the impossibility of providing a decent standard of care but I seriously doubt things have got better since I left.

https://www.worldsepsisday.org/declaration

I think it depends on where somebody was trained/works.

The service I work with work down from sepsis to other milder illnesses so I can't imagine why it is being missed so much. Very sad.

We need to start seeing far more corporate manslaughter prosecutions for incidences like this, and where professionals have failed to follow NICE guidelines. For example, failing to refer for symptoms of cancer etc.

@Kalodi I'm so sorry 😞

@Xomega - I suppose that was my next point - I think there are too few prosecutions.

It sounds like this poor young woman suffered from a number of events including 5 hours lying waiting in agony with a dislocated hip due to high volume ambulance calls. Tragic.

on the side of the ambulance and all around A&E were signs about sepsis. I went to reception repeatedly to say I could see it tracking up her leg. Was ignored for 8 hours. (She wasn’t taken in by ambulance it was in the side from one to another) The triage were so dismissive it was ridiculous. Luckily she survived but what is the point in the public being aware of sepsis symptoms if the staff are either too simple or don’t care. Got the usual letter of lessons will be learned. Bet they would do the same today.

@Wishitsnows What I found, with my son, was that I was treated like a over sensitive and dramatic mother who should "be quiet and listen to the experts".

@Kalodi am so so sorry its absolutely horrendous that happened to your child.

I nearly lost my leg and had multi organ failure due to sepsis, all because they didn't spot the signs early enough when it started with necrosis faschitis and had to have a very large portion of my leg debrided.

So sorry to hear this 💐

Like @Gracemai1 'Think Sepsis' is ingrained where I work amongst all HCPs- from HCAs through to the consultants and all of the nurses and AHPs between. It was touched upon in training but following campaigns and heartbreak from families who have lost loved ones and bravely pushed for more awareness and for it to be taken seriously we very much now do where I work. Its awful that other Trusts and settings are ignoring the signs and not listening to patients and parents. Thoughts with her family and friends and i really hope this brings about much needed change, its something we should all be aware of and should all work down from.

Yes I think this is very common still. I listened to the radio 4 interview of the mother of Martha who died ahead 13 of sepsis. It was horrendous how they treated that child and their family. The mother did say she thought alot of the attitude was down to misogyny.
None of the consultants in the ward had done the hospitals sepsis training. The consultants also had poor relationships with the next door icu. This had huge repercussions for how the child was managed. Despite the hospital having a policy that a child should be moved to icu if the parents were concerned this did not happen.

I think pp is right in that there really is no excuse for sepsis being missed nowadays, especially in a hospital acute situation. It's the toxic ethos of particular hospitals or wards that contribute largely to terrifying poor practice.

@Kalodi im so sorry for your loss.

I would also add that when you read about failing maternity units or units with avoidable newborn deaths, sepsis is always a key reason. My DD spent 2 weeks in NICU with gbs sepsis - she was rushed to NICU at 23hrs old but we had been raising concerns from about 2hrs old that we thought something was wrong. Multiple midwives dismissed us and it was only when her legs turned totally purple that they got a doctor from the neonatal unit to come and she was rushed to NICU. We were literally about to be discharged by the midwives. It would have been catastrophic if we had made it out of the hospital. So despite all the signs and all the training, i agree that something more needs to be done.

It is terrifying and disturbing that young people can lose their life to life to something so treatable.

I didn't see much detail as to how things were missed or what signs were ignored.
As a ward nurse of many years I struggle to see how basics are missed, we all know the signs. Sometimes young fit people compensate for a while (meaning their bodies can overcome and hide changes) that is why I am never 'reassured by a young person who has 'low BP because they are fit'.

We use NEWS2 and any deviation in a set parameter that flags anything above a 2 gets reviewed by the nurse in charge, we consider cause and treatment and make a plan.

I think sometimes people ignore NEWS as for example respiratory ward patients often have high NEWS due to existing heath problems.

We always think sepsis and commence the protocol even if it is stepped down once sepsis is disproven. You need to start sepsis treatment within a hour of suspicion.
I bet if the nurses on here saw the NEWS score of Maddie we could point out the problems immediately.

The staff involved should be dismissed, it is basic, sadly though, junior nurses don't always have the confidence to push a doctor who dismisses them.

We have a critical care outreach team who respond to high NEWS or other system alerts. If I am worried about a patient and Dr disagrees but I am still worried, I call them. A nurse's intuition is usually right so I don't ignore mine or my staff's.