An audit of compliance with the sepsis resuscitation care bundle in patients admitted to A&E with severe sepsis or septic shock.

Severe sepsis and septic shock are syndromes resulting in a systemic inflammatory response and the dysfunction of one or more organs following infection. The Surviving Sepsis Campaign is an international effort to reduce mortality in severe sepsis and septic shock by 25% by 2009 using a care bundle approach. It comprises evidenced-based interventions to be carried out within 6h of onset of sepsis. We conducted a prospective observational audit of 32 consecutive adult patients with severe sepsis or septic shock admitted via the A&E of a district general hospital. The compliance rate against each element, and overall compliance to the 6-h bundle were obtained. Patients' ages ranged from 55 to 75 years with 53% being male. Overall compliance was 19%. Arterial lactate was undertaken 100% of the time, and only just over half received an appropriate fluid challenge. Administration of an antibiotic was also very slow. Local recommendations include improvements to the track and trigger scoring system in A&E to improve recognition of sick patients, ensuring the doctor responsible for prescribing the antibiotic will administer it, and increasing awareness of the surviving sepsis campaign via education and training of all A&E staff. Given current evidence greater compliance to the care bundle may well improve patient outcomes for this client group.

Perceptions of critical care outreach within a network.

AIM: The purpose of this study was to establish healthcare professionals' perceptions of critical care outreach. METHOD: A multi-site survey approach was used to collect qualitative data. RESULTS: Most respondents felt that outreach assisted with patient care by enabling the admission and smooth discharge to and from the critical care units and providing useful education and training that changed practice. Respondents also thought that the audits undertaken by the outreach teams benefited patient care. CONCLUSION: Overall, outreach was considered by healthcare professionals to enhance patient care and improve practice.

Nursing observations on ward patients at risk of critical illness.

Research findings and anecdotal evidence from outreach nurses across the country have suggested that key indicators of critical illness (respiratory rate and fluid balance) are being missed on the wards and that critically ill patients are not being fed adequately. A group of outreach nurses in Kent carried out a survey to confirm or refute these claims and to ascertain the variation in outreach provision in Kent. The survey found widespread deficiencies in nursing care and observations, which represent a serious threat to patients' safety.