Background Historically, patients in hospices have not had routine physiological observations recorded, with the focus being on maintaining comfort at end of life. In recent years, more patients admitted to hospices still wish to receive active life-prolonging treatment, including for sepsis. NICE issued guidance on the recognition of possible sepsis in the community and hospital settings in summer 2016. Recognition includes assessment of patients’ basic physiological observations.
This audit was performed to assess the extent to which basic physiological observations are completed to allow careful assessment of patients in the hospice for the presence of sepsis.
Assessment for sepsis risk includes
Presence of risk factors
altered conscious state,
reduction in functional ability
new need for oxygen to maintain saturations
heart rate, blood pressure
when the patient last passed urine
Site of any likely infection.
Method retrospective review of patient records.
Results 15 episodes of pyrexia were identified in 11 patients in a four month period. Two of these were related to blood transfusion and not included in analysis. On assessment of the patients, blood pressure, heart rate, conscious state and functional level were the most frequently recorded sepsis risk factors. Skin colour, respiratory rate, presence of signs of skin or wound infection and urine output were hardly ever or never recorded as assessed.
Nursing staff requested medical assessment in all cases although this could be delayed until normal working hours. Intravenous antibiotics were started in two patients and oral antibiotics given in five. Ceiling of care was discussed in three cases.
Conclusion Decisions are made about the presence of sepsis and the use of antibiotics based on a limited patient assessment. Staff need to be reminded that fuller assessment of basic physiological observations may improve decision-making.
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