The Royal College of Nursing Congress, May 2019, saw keynote speaker, Tom Ray and his wife Nic, give a moving narrative of Tom’s survival following his recovery from sepsis. Tom’s story, now a book and film entitled Starfish, explains how his life was irrevocably changed after receiving a small injury to his mouth. A series of clinical errors and a delay in diagnoses led to amputation of both his arms and legs, removal of parts of his face and a 5-month coma. Pippa Bagnall, a former nurse, and supporter of the Ray’s campaign to raise awareness, summarised concerning statistics during their keynote speech; there are 250,000 cases of sepsis every year, leading to at least 52,000 largely preventable deaths (RCN, 2019).
Incidences of sepsis increase with age, with those suffering frailties, those over the age of 75 years or a combination of both being among the highest risk groups (NICE, 2016). Sepsis is most commonly triggered by a bacterial infection in the lungs, urinary tract, abdominal organs or skin and soft tissues (The UK Sepsis Trust, 2019). It’s likely you have a resident in your care today, conceivably every day, who is frail and/or over 75 with a chest infection, wound or UTI.
Sepsis is a complex condition that, without training, can be very difficult to identify. Nic Ray succinctly summarised an untrained view of her husband’s symptoms by saying, “It looks like a lot of things, but nothing in particular”. There is an added complexity when diagnosing residents in care homes as concerns about their mental state or behaviour are commonplace and linked to multitudinous causes. It is crucial that care home staff are attuned to their resident’s behaviour, particularly those with dementia, who lack capacity or have communication difficulties. It is important not to look at behaviour changes as an inevitable and expected outcome of a person’s condition, but rather consider what is unusual or unexpected for them. Behaviour changes are a key element in the sepsis assessment process.
The UK Sepsis Trust has developed screening and action tools for healthcare professionals and carers in various settings. The community carers tool is particularly useful for residential settings, using commonplace terminology, without the requirement of more technical observation skills (UK Sepsis Trust, 2019). NICE 2016 guidance includes sepsis risk stratification tools for adults outside of the hospital setting, which may prove useful to nursing homes with access to observation equipment such as a pulse oximeter.
Treatment for sepsis is time critical, requiring immediate action, and as Tom Ray can attest, the consequences can be life destroying, but more often fatal. Sepsis recognition training should be a mandatory subject for all healthcare staff but is particularly crucial for those working in environments that care for high-risk groups, such as residents living in residential and nursing homes.
Information on recognising and managing sepsis is now available at clinicalskills.net, in our new three-part series, which you can view as part of your free trial: see URL. Should you have any difficulties accessing these procedures, please drop us a line at: firstname.lastname@example.org
National Institute for Health and Care Excellence (NICE). (2017) Sepsis: recognition, diagnosis and early management. NICE guideline 51.
Royal College of Nursing. (2019) Keynote speaker: Tom and Nic Ray. [Online Video]. 22 May 2019. https://webcache.googleusercontent.com/search?q=cache:viIcdU4nAOoJ:https://www.rcn.org.uk/congress/whats-on/keynote-speaker-wednesday+&cd=1&hl=en&ct=clnk&gl=uk&client=firefox-b-d#Wednesday-watch
Triggle N. (2019) I lost my arms and legs – stop it happening to others. BBC News Online.
Tom Ray. (2019) Resilienceand.co [Online] Available at http://www.resilienceand.co/