How it started
In 2013/14, an audit of patients who had been admitted to ITU with sepsis highlighted the need for improvement in patient care. A grant was obtained to set up and run multi-professional simulation training sessions in collaboration with St. Thomas Hospital. This was followed-up by our successful bid for a ‘Sign up to Safety’ project from NHS England in January 2015 followed by a new national sepsis CQUIN (commissioning for quality and innovation) for 2015/2016.
The Project aims and objectives
The overall aims of the Sepsis Quality Improvement Project are:
In order to achieve our aim, our main objectives are to:
Sign-up to Safety
The Sign Up to Safety initiative commits us to putting patient safety first, continually learning, being honest in what we find, collaborating so that improvements can be spread and supporting people to make things better. We were granted £100,000 to spend over three years on the project – for a Sepsis Nurse and training. The project began in June 2015 with the Sepsis Nurse beginning in post as of September 2015.
As part of this initiative, we have set out yearly goals to demonstrate progressive improvements over the three years. These goals focus on measuring improvements in delivery of three main interventions and one diagnostic test within one three hours of a patient becoming septic. These are based on elements of the Sepsis 6 Bundle. These include:
The Sepsis CQUIN
A new national CQUIN aimed at demonstrating an improvement in the recognition and management of sepsis was introduced for 2015/16. CQUIN is a system of payment which allows commissioners to reward excellence, by linking a proportion of our income, as a healthcare provider, with the achievement of locally agreed quality improvement goals.
The CQUIN for 2015/16 focused on the emergency department and included auditing to:
In 2016/17, we continued to audit our progress in regards to sepsis screening and antibiotic administration within one hour of arrival in the emergency department but have extended our audit to include inpatient services as well. Our antibiotic administration audit also included whether or not a patient received empiric review of their antibiotics within 3 days of being commenced on antibiotics.
In sepsis, antibiotics are often begun on the basis of a clinical educated guess in the absence of complete or perfect information such as a positive blood culture result. Treating sepsis is time-critical so it is important to start treatment based on good information rather than waiting for better information in order to minimize morbidity, risk and complications. An empiric review of antibiotics in meant to occur as better information (e.g. cultures) become available. This ensures that patients are on the best antibiotics for their particular source of infection.
The specifications of the CQUIN audit continue to be added to year upon year. You can find the latest CQUIN guidance on the NHS England website. The sepsis CQUIN comes under the title of ‘Reducing the impact of serious infections’, but its three core elements relating specifically to sepsis are listed here:
For 2018/19, the audit results for the emergency department and inpatient samples are reviewed separately but reported quarterly as a combined result. To see how we are doing, please visit our audit page.