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:

Im an adult A&E nurse and page 2 of the admission booklet for any illness is think sepsis. As soon as that first set of obs is done sepsis would flag and treatment inline with sepsis pathways would begin. It is drilled into every member of staff. Although i do my own obs i dont ask my HCA to do them unless I am really busy and then i will only ask them to do ones on patients i know would be low scoring due to the nature of their admission such as injurys rather than illness.

However. I have been into the childrens A&E at my own hospital, and the treatment was radically different. My child waiting over 7 hours for pain relief, it took more than 2 hours to be triaged. I wouldnt be surprised if the response to sepsis triggers were different there. I found the differences between adult and child ED mindblowing and i did speak to my seniors, who work across both departments about how shocking i found it.

I also have worked on wards in the past in a different trust, wards where staffing was awful. I have witnessed first hand HCA's making up obs results, and lying about completing personal care (part of the reason i now do all my own obs as much as i can) and it wouldnt surprise me sepsis red flags being missed in those areas either.

I feel personally, only nurses that are trained should complete observations and documentation. 90% of HCA's are worth their weight in gold and do an absolutely amazing under appreciated job in the hosp. Some, just dont have a clue, have no training, and no motivation to learn for themselves, and i feel this is why things are missed as more and more that nursing task is being placed on untrained unqualified members of staff. In my nurse training we had a whole semester long module which was based around sepsis, the triggers, the response, the immediate nursing interventions, the importance of escalating, how to escalate and ensure your point is made quickly and clearly so the medics will get a clear overview, and how to give your expectation of what should happen to a medic who is your senior.

I also think sometimes as a nurse you have to be very proactive and assertive to get medics to listen to you

@Kalodi I'm so sorry what happened to your son and for how you were treated that's horrendous

My mum was admitted straight into oncology after presenting with pretty much every symptom of sepsis, with previous admissions due to infection/borderline sepsis and 10 days post-chemo. Having been with her for the previous admissions I told them I thought it was sepsis.

She was actually treated for dehydration for 15 hours before someone actually read her blood results, by which time it was too late and she died 20 hours later.

It is unbelievable to me that in oncology, post chemo, with all but one symptom and a family member with full history, the entire team did not consider sepsis and start treatment protocols before the bllod results (the investigation into her death even questioned why she was not treated with antibiotics. It was a major fuck up, actually a series of fuck-ups, and a 'preventable death').

It does happen. Even in specialist departments with posters on every wall advising query sepsis.

I'm not sure prosecution is the right way though. It's often a combination of factors rather than one or two people you can take to court.

Ultimately the problem is lack of doctors and nurses and prosecuting them would increase this further. Unfortunately doctors and nurses are still human and very sadly things do get missed, of course they should be held to account and there should be NMC/GMC hearings but it is difficult.

I name changed for this but I had an awful UTI that didn't respond to treatment and I was seriously ill but the advanced nurse practitioner said I couldn't keep having antibiotics (I'd had a couple of courses) and wouldn't actually see me even though I said my heart rate, temperature and pain were really bad. In the end my mum had to go to the surgery to complain and I was admitted to hospital that day with sepsis I couldn't even recognise my own details by the time the GP examined me it was so scary. It doesn't compare to what has happened to other families but it was scary what could've happened if my family accepted the ANP response

I completely agree. Especially regarding nurses having to be proactive and assertive. It was always in my head that we were the patients advocate. Experienced and highly qualified nurses have to have a very thick skin and be extremely persistent sometimes to get the patient the help they need.

This was meant to quote the post by confusedagainn

There are no excuses. Absolutely appalling. The system continues.

I’ve worked in ICU long enough to have concerns at the obsessive community and management focus on sepsis at the cost of other life threatening reasons for organ compromise. Antibiotics have no place in the treatment of most of them. Additionally I have personally cared for two children who almost died because their parents, following community sepsis campaigns, were falsely reassured by the absence of a fever and missed other vastly more concerning signs of severe systemic illness. They presented in extremis.

The diagnosis and treatment of life-threatening illness is simply nowhere near as clear, obvious or simple as the posters would have you believe.

Definitely.

But then we are putting NQNs who can be as little as 2 weeks into the job, in charge of bays of sometimes 12+ patients and expecting them to have the skills and confidence to be assertive and argue with medic who have been in their roles for years. And them being able to work fast enough to care for that many patients without something being missed. It just doesnt happen.

It comes back to staffing time and time again. We dont have the staff to keep NQNs supernumerary for longer. We dont have the staff to ensure there is a good skill mix on wards. We dont have the staff to ensure NQNs have smaller case loads whilst they find their confidence etc. We depend on unqualified staff more and more. And this is why care declines.

The system is a mess. I love my job, its a huge part of my identity. But i really dislike the way it is at the minute and cant see it improving.

Ds is in his late teens now but was sent away unwell with sepsis after a consultation with a GP. He had peri orbital cellulitis and was a year old. He was already on oral antibiotics but they were doing nothing. Even the receptionist commented on how poorly Ds looked when I took him in. The GP told us to wait another 48hrs before seeking help again, to give the antibiotics time to work. If I had, I don't think Ds would be here now.

I took him to A and E about 2hours after seeing the GP. And he spent a week in hospital on IV antibiotics.
I made a complaint to the practice manager, as a different GP advised me to do so. She said that it would help raise awareness.

Corporate manslaughter protections would focus on the organisation, not individuals.

If individuals had failed in their duty of care then further prosecution may be appropriate, but that is the case now.
https://www.thecorporategovernanceinstitute.com/insights/guides/what-is-corporate-manslaughter/

My DD had sepsis when she was 8 months old. I was dismissed by 2 GP’s as being viral, we finally took her to A&E after she was presenting with sepsis symptoms. I was again dismissed by a “junior” dr as just viral. My DD had been in SCBU for 3 weeks when born as she arrived at 33 weeks. I saw a paediatric registrar that looked after my DD when born and insisted that she take a look at her. She also said that she didn’t look septic but she couldn’t dismiss what I was saying as a mother.

they look some bloods and her CRP levels were 260. It was then panic stations, they injected her with antibiotics and transferred us to a bigger hospital. She was hooked up a IV drip and had to have a lumbar puncture as they suspected meningitis. Luckily it came back clear but she had to continue on the IV antibiotics for a further week. They never found the root cause of the infection. We all suspected urine infection but because she had been blasted with such strong antibiotics by the time they got a urine sample it was clear.

it’s left me with health anxiety, I’m now on anti depressants and am due due start cognital behavioural therapy soon. Every time there is a case like this in the media it sends me spiralling and I have dreams about finding her in bed and can’t wake her. I think about the what if I’d not seen that dr that cared for her, would we have just been sent home again. Thank god she is ok and my heart goes out to @Kalodi im so so sorry for your loss

my DD’s symptoms were a high temperature that couldn’t be brought down. No cough, no snotty nose, no other traditional symptoms of illness other than the high temperature and being very quiet

I urge any parent to insist on a CRP test in hospital, it’s a very simple test and they can get the results very quickly

cases like this are so heartbreaking and totally preventable

I also think that the new method of obs being recorded electronically doesnt help. My dept we still record on paper, where the lines are coloured in accordance with the NEWS score so you immediately if they are scoring 3 in one area which triggers sepsis, or multiple in 2 and 1 and would trigger sepsis. The hand held devices are so easy to put all the numbers in press "ok" "ok" "ok" without actually seeing what the results are and an unqualified could just go about their day not even being aware that patient was scoring high enough to trigger. I feel this is one of very few cases where the old paper system was better. You can see trends on paper as they are all next to each other, you can see if something is out of range from that persons base line easily which you cant on the hand held devices. You get a better quicker clearer overview of your patient.

I actually wanted to do my dissertation on whether paper v electronic observations increased nurses awareness of the patient they were caring for but i couldnt find enough research into it.

So for the rambling, but this is a topic im very invested in.

What I have learned from Martha’s story is that every parent should learn the signs of sepsis themselves. If I ever have a sick child and suspect sepsis and am being ignored I will shout from the rooftops. I am sure there are multiple reasons why but it just seems as though we can no longer fully place our faith in doctors saving our children’s lives. Be that parent who calls 999 while in the hospital, write to their legal team threatening a court order, email the hospital director and contact The Sun.

Not sure I agree. When we enter observations if the NEWS is 0 that is the end but, the system flashes a warning up with advice as to what action is needed if the NEWs is 2 plus. Also because it is electronic it is flagged to critical care and the Drs can access it immediately from anywhere so, when you call them they can see the parameters. You cannot miss the warning of high NEWS.

Also of note, is paper copies get lost and can be altered. I have worked long enough to have used paper and electronic and can see electronic is safer. Electronic also compiles other warnings so we get early notifications of AKI for example.

I accompanied a relative who was found in a state of collapse to our local hospital and sepsis was the default treatment from when he entered the ward. He spent almost a month in intensive care but survived virtually unscathed.

Also NEWS2 electronic version is timely, has the name of the HCP who entered the obs and flashes a colour depending on response so, red is for the highest score. People can therefore be challenged on why no action was taken

Like a previous poster it would be ideal if trained staff took observations but they have so much else to do, we have taken over a lot of the Drs roles however, it is our responsibility to check that the observations are satisfactory.

No one should be dying of sepsis these days it is so treatable 😔.

Drs being able to access results every where is a definite benefit i agree. As well as misplaced notes being common. Electronic obs can be altered though. Ive witnessed obs being striked off systems and re entered. But the system our trust, while it does flash up as being a sepsis trigger, you can just "ok" through those last screens very quickly. The actual sepsis pathway question only trigger if its a nurse access code too, the HCA access code doesnt take you to the pathway, it depends 100% on the HCA informing a nurse and the nurse then accessing the patient. It also doesnt show previous obs for that patient unless you go through a rather long winded series of screens to look and i feel knowing a patients baseline is important information at times.

I definitely think that the biggest issue is untrained staff completing obs, not being aware of when to escalate, or waiting to escalate if the trained staff are busy, and staffing levels impacting care. But i do think there are some negatives to electronic documentation over handwritten, as well as some positives.

It sounds like the system you use if potentially better than the one we do, ours doesnt flash up colour according to scores entered, just the final screen has a banner that has the score in and advice for when the next set would be due. A nurses access would have the sepsis pathway triggered if they scored, however most nurses arent doing the obs in ward areas, due to as you say, not having the time due to their workload increasing. But the time when they are due can be over ridden. For example my first role was on a surgical ward, where anyone post surgery would be set to 15 minutes for 2 hours, 30 minutes for 2 hours, hourly for 2 hours. This would over ride the default based on the score.

Possibly a slightly different system then. Ours only gives you about a minute to alter obs, you cannot go back and do it, anyway it would still be seen on the system someone had altered it (not that, that would help at the time of course) we can look at 24 hours worth of obs on one screen with colour depicting the high NEWS.
Why are the systems not all set the same?

Part of it is an attitude problem. In postnatal care in particular, there is a real issue with women raising that something is wrong, and they are dismissed by staff as having low pain threshold. Happened to several of my friends.

I agree but think it extends to a lot of conditions relating to women there is often an attitude of having low pain threshold / overreacting

Yours is definitely much better. Ours can be striked at any time. And you cant see 24 hours just a list of all previous results taken but its not simple to find.

I also saw that a lot would go and do an obs round with a paper and a pen, then come back and enter them onto the electronic device after due to a shortage of them. If the HCA was doing 12 sets of obs, with all the usual interruptions, it can take well over an hour to do them all. Then adding them to the system. If that first patient was triggering, that initial hour for the pathway has already been missed by a large amount of time before they are even recorded.

This is part of the reason i wont work on wards ever again and prefer the ED and hope to one day go into community care. Ward level care and staffing terrifies me.

I am a surgical/ medical ward nurse. It is the staffing but it never really gets flagged often, incidents are put down to nursing lapses rather than looking at the organisational factors.