Headlines

Sepsis

Sepsis arises when the body’s response to infection spirals rapidly out of control, injuring its own tissues and organs.

Sepsis can be triggered by an infection in any part of the body – even an ingrowing toenail.

It is indiscriminate and potentially deadly.

Reacting quickly and treating fast, rapidly improves survival rates

Key things to look out for - especially if unwell with infection or has a wound that looks inflamed – think could this be Sepsis?

• Very high or low temperature
• Uncontrolled shivering
• Confusion
• Passing less urine than normal
• Blotchy or cold arms or legs
• Patient reports feeling like they are going to die sometimes with extreme pain and sense of impending doom

What can we do?

Prevention of infection

• Keep vaccinations up to date
• Keep wounds clean
• Practice good handwashing
• Take anti-biotics as prescribed – always finish the course

If you suspect sepsis

• Establish the patient’s baseline and be alert to differences.
• Stay curious – don’t assume presentation is due to MH disturbance or drug use – it could be sepsis.
• Calculate NEWS-2 score – act accordingly.
• If you are worried, ensure full and prompt assessment and escalate early if required.

• Clear and accurate documentation is a crucial part of patient care. It facilitates information sharing between healthcare staff, allowing teams to contribute to ongoing risk evaluation, and can be used both clinically and legally.
• Records should be prompt, accurate and legible. They should be structured with subheadings to help others quickly find the information they need. 
• Records of patient interactions can be broken down into three stages: 
  • 1. Incident background (Context or reason for them being seen)
  • 2. Patient assessment and treatment 
  • 3. Care planning.
• Common pitfalls with documentation include: using colloquial or judgemental language, omitting essential background information - assuming that others are aware of the wider context or that the information is captured elsewhere – and forgetting to include specific templates relevant to patient assessment.
• Tips for improving documentation practices:
  • Document as if handing over to a colleague who has never met the patient.
  • Practice documenting under subheadings / following the structure above
  • Set up systems for the safe handover of patient information e.g. high-risk patient folders and regular schedules for review.

• The ACCT (Assessment, Care in Custody and Teamwork) is a prison led care planning process for individuals at risk of self harm or suicide.
• This process is just one part of multiagency risk management.
• Sometimes decisions around whether someone is on the ACCT process can be complex and nuanced.
• When making difficult decisions, always seek support and document your decision making clearly.
• Also consider other possible risk management strategies and interventions such as engaging with the gym, families, peer support, Chaplaincy, Samaritans and substance misuse teams.
• If you're in the healthcare team, always talk to and involve your prison colleagues and vice versa.
• It can be easy to get caught up in the process, always keep the person at the centre of what you're doing.

• If suspecting someone of using SPICE, stay curious, they may be drowsy because of other prescribed medication, check for recent changes.
• See SPICE use as an opportunity to educate the patient in a non-judgemental way about risks, especially if also taking anti-psychotics.
• If declining to administer medication because you suspect the person may be sedated or intoxicated, contact the prescriber and share your thoughts.
• If you are a prescriber and your patient is regularly using SPICE consider taking ECG measures and alternative prescribed medications that may be safer.
• When SPICE use is suspected, avoid quetiapine and other antipsychotics that prolong QTc; studies show that aripiprazole and olanzapine are the most cardiac safe in this scenario.