Anne Hunt, Gina Creasey, Rebecca Drakes, Sarah Gilbert, E & N Hertfordshire NHS Trust Sepsis TeamJenny Gallimore, Kate Harding, Astrid Ubas, Health Liaison Team, Herts County CouncilAndy Cashmore, Lucy Preece, Debbie Pinkney, Hertfordshire Partnership Foundation Trust

Preventing Sepsis amongst Adults with Learning Disabilities: an inter - agency approach

Why Adults with Learning Disabilities?An estimated 0.5% - 2% of the UK population have a learning disability (Emerson & Baines, 2011; Hosking et al, 2017). This can range from mild disability where the person lives independently through to profound disability with complex needs. For a county the size of Hertfordshire, this equates to between 5,800 & 23,000 people. People with learning disabilities suffer greater health inequalities (Emerson & Baines, 2011) and are more likely to die prematurely (Heslop et al, 2013) thanpeople without learning disabilities. Infection and organ failure was the final pathway to death in 3 of the 6 NHS patients with learningdisabilities described in Death by Indifference (Mencap, 2007). People with Learning disabilities are five times more likely to be admitted to hospital with a lowerrespiratory tract infection or a urinary tract infection than someone of the same age & sex without learning disabilities (Hosking et al, 2017).The Learning Disabilities Mortality Review is scrutinising events leading to the deaths of all people with learning disabilities in the UK: www.bristol.ac.uk/sps/leder/ and will identify the extent that sepsis is a cause of avoidable death in this population.

Why Prevent Sepsis?Over a quarter of a million people in the UK are thought to develop sepsis every year(Hex et al, 2017). Of these, at least 36,000 people die (NHS England, 2015).Screening for sepsis when a patient deteriorates and swift treatment with the ‘Sepsis Six’ care bundle reduces mortality (Daniels et al, 2010) and could save 14,000 lives each year (UK Sepsis Trust, 2018). Sepsis screening and treatment are subject to financial incentives in NHS trusts which includes mandatory audit of these indicators (CQUINs)(NHS England, 2016)Sepsis always starts with an infection; most commonly, infections of the respiratory or urinary tracts (NCEPOD, 2015). Patients are more likely to develop sepsis in the community than in hospital (NHS England, 2015). Each context provides distinct opportunities for sepsis prevention.

If Sepsis is suspected and patient has any one red flag,Sepsis Six required within 1 hour: If peripheral IV access not obtained within 30 minutes please proceed to Intra Osseous (IO) access and/or consider IM antibioticsVascular Access Algorithm – adapted from IO policy

SurveillanceSepsis Team monitor in-patients with learning disabilities for early

signs of sepsis Earlier intervention on wardsReferrals from LD Liaison nurses

Supported by eObs

Intra-osseous (IO) needle insertion training

ED / AMU / CCOT

Sepsis CQUIN auditEmily*

19 years oldLearning DisabilitiesSeptic shock twice

Source: UrineDelayed administration of IVABs on both occasions investigated

Outcomes Emily: 3rd episode of sepsis

Arrived ED: amber flagsIV access & Sepsis Six

promptly

Better HealthBetter MeHealth for All Community Learning

Disabilities Nurse and Carers

Individual family carers follow up & education &

Carers Forum

Health Liaison TeamInteragency Sepsis Group

Reasonable Adjustments Objective & Subjective

observations

Equality Act (2010)

Health Passports

Sepsis screening in Top to Toe file

Health Liaison Team Teaching on Sepsis Study Days content included at sepsis teaching sessions

Easy read leaflet & poster

Research Question:What is the Experience of Sepsis

amongst Adults with Learning Disabilities?

What is the Experience of Caring for Adults with Learning Disabilities?A small scale, qualitative study

Professional Doctorate in Health Research (DH Res)

OutcomesWider audience & better access to community, GP and hospital groups, raising awareness of both sepsis and the needs of people with LD

References

Daniels R, Nutbeam T, McNamara G & Galvin, C (2010) The Sepsis Six and the Severe Sepsis resuscitation bundle: a prospective observational cohort study Emergency Medicine Journal Vol 28 p 459-460 https://doi.org/10.1136/emj.2010.095067

Emerson, E & Baines, S (2011) Health Inequalities and People with Learning Disabilities in the UK Tizard Learning Disabilities Review Vol 16, Iss 1, Pg 42 – 48

Heslop P, Blair P, Fleming P, Hoghton M, Marriott A & Russ L (2013) Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) http://www.bristol.ac.uk/media-library/sites/cipold/migrated/documents/fullfinalreport.pdf (accessed 24/11/17)

Hex, N; Retzler, J; Bartlett,C & Arber, M (2017) Whitewater Charitable Trust: The Cost of Sepsis Care in the UK York Health Economics Consortium.

Hosking FJ, Carey IM, DeWilde S, Harris T, Beighton C, & Cook DG, (2017)Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England ANNALS OF FAMILY MEDICINE Vol 15, No. 5, p462 - 470

Mencap (2007) Death by Indifference https://www.mencap.org.uk/sites/default/files/2016-06/DBIreport.pdf (accessed 24/11/17)

NHS England (2015) Improving Outcomes for Patients with Sepsis Publications Gateway Ref 04457 https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf (accessed 24/11/17)

Sepsis Awareness Raising by Sepsis Nurses to community LDservicesKnow the SignsSeek Medical help urgently if you or someone in your care, develop any one of the following:Slurred Speech or confusionExtreme shivering or muscle painPassing no urine in a daySevere breathlessnessIt feels like you’re going to dieSkin that is mottled or discoloured

Patient requires Vascular Access: if red flag sepsis IVABs required within 1hr

Systolic Blood Pressure >90mmHg? No

Yes: 30 mins to obtain IV access Can access be gained in 2 mins?

Yes No

2 regular attempts at peripheral IV access

2 further attempts at peripheral IV access: consider using USS / infrared

Intra -Osseous access