The inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision-making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.
Physicians newly qualified to consultant level participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached.
Twenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision-making of individual physicians were (1) perceptions of providing ‘optimal’ care for the patient with infection by providing rapid and often intravenous therapy; (2) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; and (3) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort.
Interventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy must be urgently addressed with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.
Sepsis awareness campaign will help parents and carers of young children recognise the symptoms of sepsis.
A nationwide campaign has been launched to help parents spot the symptoms of sepsis to protect young children and save lives.The campaign is principally aimed at parents and carers of young children aged 0 to 4.
The campaign, delivered by Public Health England and the UK Sepsis Trust, follows a number of measures already taken by the NHS to improve early recognition and timely treatment of sepsis. This includes a national scheme to make sure at-risk patients are screened for sepsis as quickly as possible and receive timely treatment on admission to hospital.
Leaflets and posters are being sent to GP surgeries and hospitals across the country. These materials, developed with experts, will urge parents to call 999 or take their child to A&E if they display any of the following signs:
looks mottled, bluish or pale
is very lethargic or difficult to wake
feels abnormally cold to touch
is breathing very fast
has a rash that does not fade when you press it
has a fit or convulsion
The UK Sepsis Trust estimates that there are more than 120,000 cases of sepsis and around 37,000 deaths each year in England.
The purpose of this report is to provide a broad understanding of the current provision of sepsis education and training for healthcare staff across England. The report includes examples of good and innovative practice in sepsis training and highlights high quality educational resources which could be promoted nationally for use in sepsis training.
The Royal College of General Practitioners (RCGP), in partnership with Health Education England and NHS England, has launched a Sepsis toolkit to support GPs and healthcare professionals to identify and manage the condition.
The toolkit provides a collection of tools, knowledge, and current guidance to support the identifying and appropriate management of patients with sepsis. The toolkit is aimed at GPs and healthcare professionals assessing people in the community with acute infection.
The toolkit also provides valuable information for patients, carers and parents, including an adult and child sepsis ‘symptom checker’, to illustrate the signs and symptoms they should look out for.
NICE has published new guidance Sepsis: recognition, diagnosis and early management (NG51). This guideline covers the recognition, diagnosis and early management of sepsis for all populations. The guideline committee identified that the key issues to be included were: recognition and early assessment, diagnostic and prognostic value of blood markers for sepsis, initial treatment, escalating care, identifying the source of infection, early monitoring, information and support for patients and carers, and training and education.
The UK Sepsis Trust will support release of the NICE Clinical Guideline on sepsis with tools and resources including screening and action tools to aid with early identification and management of sepsis in children and adults (including in pregnancy) across community-based, prehospital and acute clinical environments.
Mount Sinai School of Medicine. ScienceDaily. Published online: 28 April 2016.
Researchers at the Icahn School of Medicine at Mount Sinai say that tiny doses of a cancer drug may stop the raging, uncontrollable immune response to infection that leads to sepsis and kills up to 500,000 people a year in the U.S. The new drug treatment may also benefit millions of people worldwide who are affected by infections and pandemics.
Their study reported inScience, demonstrates in both cells and animals that a small dose of topoisomerase I (Top 1) inhibitor can dampen an acute inflammatory reaction to infection while still allowing the body’s protective defense to take place. The title of the study is “Topoisomerase 1 inhibition suppresses the transcriptional activation of innate immune responses and protects against inflammation-induced death.”
The treatment may help control not only sepsis — deadly infections often acquired in hospital by patients with a weak immune system — but also new and brutal assaults on human immunity such as novel influenza strains and pandemics of Ebola and other singular infections, says the study’s senior investigator, Ivan Marazzi, PhD, an Assistant Professor of Microbiology at the Icahn School of Medicine at Mount Sinai.