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:

This is something that is very much currently in my mind at the moment, my adult son has recently had to have a third of his foot amputated due to sepsis, he was back and forwards between the hospital and the foot clinic due to a diabetic foot ulcer not healing, when his symptoms got worse, severe swelling, colour change, high temp, nausea he went back again to a&e asking to be admitted, they refused and sent home telling him to give the antibiotics which he had been taking for the past week chance to work and to come back in after the weekend if no improvement. There were so many red flags, diabetes, infection getting worse despite antibiotics, colour changes and swelling, nausea and temperature, I really don't see how they didn't immediately think sepsis.

My daughter nearly died of sepsis following an infected chicken pox spot. She was on intravenous antibiotics (of a types that didn't work on the specific bacteria) but not improving. I strongly felt she was deteriorating. She already had a high temperature but her skin tone and breathing and responsiveness changed. Sadly I was dismissed over and over again as over anxious by all ward staff and had to go into hysterical mother mode (easily done given how worried I was) before anyone took me seriously. I literally forced a doctor to examine my daughter (ignoring being yelled at) and she was then put on nuclear grade antibiotics and made a full recovery. The staff later admitted to me that a child had died of the same thing in the ward not long before and another had had an amputation, again, the same thing, and my daughter would have died had I not done what I did. Horrendous.

How awful, so sorry for your loss.

My uncle is in ICU with sepsis following an operation. My aunt had to raise hell for him to be seen and when he was, the doctor was in shock as apparently the obs recorded were completely out of line with how he was presenting and he was in critical condition.

I also almost died of sepsis after being repeatedly dismissed.

@confusedagainn I think this is part of the problem that sepsis doesn’t always present how you expect or when you expect so you say you only ask the HCAs to do obs on patients you know would score low because they’re admitted due to injury rather than illness, sadly that probably included this young woman who came in with a dislocated hip. There’s always the risk that you see what you expect to see and it’s so hard to overcome that, that’s where the repeated efforts to raise awareness can be useful - but are obviously competing with all the other essential learning for hospital staff. Basically I think we need more time and more staff to improve things.

Definitely, but there are times when i cant physically complete obs on every patient when they are due and would have to delegate some to a HCA so i would chose the patient/s with the least risk, which would be the younger patient with an injury who had consistently scored zero. And i would look at the obs written by a HCA after. I would also only ask certain HCA's in the team to do so, theres some who offer and i would refuse and do them myself, or redo them if they had done them without my knowledge.

Humans are amazing but flawed.

Doctors as humans can go down a track and miss something.

Instead of pretending this doesn't happen, we need to accept it and work with it. Clearly more sepsis training/processes are needed, because we keep seeing cases where it has been missed.

My son also died of sepsis,took him to four different hospitals they refused to do blood tests saying it was a stomach virus I should of screamed and shouted but I didn’t I trusted he was nearly 4 if they would of listened at the first hospital they would of seen his appendix had burst ,he wasn’t reacting when pressed on his tummy and apparently it’s very unusual for a 3 year old it destroyed our family I miss him every hour of every day

I know a Dr in a hospital last night, the team was one down and they were bleeped over 80 times, so one person having to attend to something different every ten minutes and that is an optimistic assessment of time per patient, and doesn’t allow for time running up and down the wards

I am so sorry for your loss too @Motherland2624

I am so sorry for your terrible loss, Kalodi.

There is definitely a pattern with these cases (see also the Martha Mills case) of mothers’ concerns being dismissed as anxiety or hysteria. Merope Mills is campaigning for the legal right to a second medical opinion, which seems a good idea to me.

I'm not in the UK but a few years ago I had sepsis. I knew something was really 'wrong', I had had a miscarriage and about a week later I was feeling very ill. I was throwing up, had a temp, by the time I was waiting in A&e I was considering going for a nap in the corner as I just couldn't keep my eyes open. I remember when I was first being triaged seeing a 'think sepsis' type poster on the wall and thinking huh, that sounds like me. Thankfully for me the Drs did think sepis. I was given so many antibiotics while they waited for blood tests back, I was given a d&c, once the blood tests came back they knew what antibiotics were needed and I was blasted with them. It was a very scary time but I'm really grateful I was taken seriously from the beginning even though all I could really articulate was that something felt really wrong and that I knew I was really sick. I was afraid that they would think I was some kind of hypochondriac but instead, they listened to me.

@confusedagainn If you hate all of your HCA's just say so. The language you use is appalling - the unqualified - the untrained. I would refuse to work with you. You are the nurse. You are responsible for the patient and I have a feeling from your posts you don't take kindly to 'the unqualified' notifying you of your patients condition. I have worked with nurses like you & it is awful. I do observations & chart patients and I am bloody fantastic at my job thanks. I have no issue with going straight to the consultant if I have a feeling something is 'off' with my patients if my nurse is too busy. Luckily where I work there is a mutual respect between all levels off staff & the doctors know if I'm concerned it's for good reason. Imagine that, me, the unqualified.

The problem is when you’re too far gone with sepsis and you might not even think you’re unwell, so you are reliant on others around you. You need them to be on the ball. My GP failed me spectacularly and I know she was devastated and expected me to make a complaint but it wasn’t the outcome I wanted. I asked them to make sure it never happened again to another person and to change their training and methods. They did this.
I had septic shock and multi organ failure. I was intubated and ventilated in ICU for weeks and never fully recovered, although I am immensely grateful for the care I received because I survived it. I was so starved of oxygen, so unwell, I was hallucinating and delusional. Fortunately, I have no recollection of any of it, this is what I was told by family. So, if you know you feel really unwell, that’s one thing but if you’re like me and too far gone by the time you’re in medical care, you need the medical professionals to be watching you like a hawk.

Jason Watkins made a programme about his daughter dying of sepsis
https://www.itv.com/watch/jason-and-clara-in-memory-of-maudie/10a1660

People need to prosecute the Government. Hold them to account. Even the best nurses and doctors in the world will make mistakes when they are stretched beyond breaking point.

I very clearly said 90% of HCAs i have worked with are amazing and undervalued for the role they do in the hospital. But some are not. Ive worked in my dept long enough to know which few, a small minority, i wouldnt ask to do obs having seen them document incorrectly. But they are untrained, and if something were to happen to a patient in my care and obs were not correctly recorded, its my PIN on the line, not theirs. If someone is clinically unstable i would not ask - and nor should a HCA be responsible for doing those observations.

I also was a HCA, for over a decade, prior to my nursing, in an acute hospital setting, and for the vast majority of my time as an HCA, observations were not part of that role. I took on that role in my latter years, alongside many others that should really be a nursing job due to changes in roles in the whole hospital setting and nurses no longer having time to d it all themselves. I believe they still shouldnt be part of that role unless they have been trained and are in a band 3 or 4 position and have the title of CSW or NA or the old AP's. Same as i dont agree with HCA's at band 2 doing venepuncture, categorising pressure sores and simple dressings, doing ECGs etc etc. As a band 2 if you are being asked to preform these, i firmly believe you should be questioning your banding, receiving some formal training through your trust, and being paid accordingly with the responsibility that is being placed on you.

I have nothing against HCA's at all. The vast majority i have worked with and alongside are worth their weight in gold and a hospital would not function without them.

We have to watch that video every year on our resuscitation training. A big chuck of the day is about sepsis recognition.

My hospital have recently changed the paperwork for recording vital signs in order to flag up sepsis sooner

Different forms for acute, emergency and community staff

@Allthecatseverywhereallatonce our PEWs system is colour coded and you can also change the screen view to a chart to see trends. I would not want to go back to paper charts again. How we one trust I've worked at, theirs is all green. So you don't get the visual prompt to alert you.

My department do NEWs hourly, but I’m in ED. They should be done 4-12 hourly on ‘stable’ patients but as a nurse you need to use your knowledge and skills.
I have very rarely come across a doctor that doesn’t value the nurse looking after a patient and even when that has happened rationalise your concerns and they listen. We are the eyes and ears.
In my opinion, and I wasn’t there so it is just that an opinion, the child and their family were failed. 16hrs without observations is not acceptable.

 to you and @Kalodi

I'm very sorry x

@Kalodi and @Motherland2624 I am so sorry for what you have been through I cannot begin to imagine. This is why I work with adult patients I couldn't bear the loss of a child.

My DD had sepsis at 3 weeks old and very nearly died. I cannot thank the staff at Birmingham Children's Hospital enough for recognising how seriously ill she was and saving her life.
Before that I didn't know enough about it or how serious it is. Anything to promote the warning signs of sepsis is beneficial in my opinion.
to all of those who have lost loved ones.

I agree, and even unqualified healthcare assistants should know the signs and tell people with more qualifications immediately. Any of us would think sepsis as lay people so why on earth not people in hospitals?

The culture in the NHS has to change, - we've had this, multiple maternity care scandals and Lucy Letby. Whistleblowing has to be acted on, staff have to listen to each other, and patients put first. Most staff do that, even if they are overworked, but there is a rotten minority who cause a great deal of tragedy and trauma.