Sepsis is our number one quality priority: Day 22 of our campaign

November 22, 2018

Message on behalf of Maternity:

Maternal sepsis is defined as “Any pregnant or recently pregnant woman (up to 6 weeks postpartum) diagnosed with severe sepsis (irrespective of the source of infection)”. Mortality due to severe sepsis during or after pregnancy has been one of the leading direct/ indirect causes of maternal death in the UK over many years. Maternal sepsis can, if not recognised or treated quickly, cause a rapid deterioration in a pregnant woman or new mother, leading to septicaemic shock and eventually death.

There are a number of recognised risk factors for maternal sepsis, including caesarean section, anaemia and co-morbidities, with screening and treatment extending to ensure the unborn, or newborn baby is also considered as ‘at risk’ (albeit maternal wellbeing takes precedent, legally, over consideration of the unborn baby). The key to ensuring positive outcomes remain early identification, screening and, where indicated administration of antibiotics within the ‘golden hour’.

Whilst it is essential that sepsis is considered when women present with associated symptoms, application of the ‘medical model’ of sepsis screening is not entirely appropriate in the maternity care setting. For this reason, SWBH maternity services worked with the National Lead for Sepsis UK and partner organisations to develop a regional maternal sepsis screening tool. Implementation of this tool has seen a significant reduction in the number of pregnant women being treated for sepsis when this is not the reason for ‘abnormal’ observations; as a result of this, fewer newborn babies have received prophylactic IV antibiotics that were not clinically needed. Examples of situations where treatment initiation was triggered include labouring women whose heart and respiration rates were elevated and who also had an increased temperature but who were clinically well. When in labour, it is normal for heart and respiration rates to increase together with body temperature hence a different threshold for these was essential, based on evidence, to ensure the right women were triggering for sepsis screening and treatment at the right time.

All of our babies who require neonatal unit care are screened and receive prophylaxic treatment for sepsis; newborn babies are some of our most vulnerable patients and so we must ensure they are protected against the risk of sepsis which can further complicate their recovery journey.

Multi-professional mandatory training includes sepsis screening and management, with case based scenarios – these are presented to the MDT participating, with skills drills opportunities to ensure all of the team are well rehearsed in the provision of proactive screening and responsive, evidence based treatment with the emphasis being on timeliness to prevent harm. We are very proud of how the team have adopted this approach and also the high compliance with the evidence base, ensuring our women and babies receive the right treatment, in the right place at the right time and avoiding unnecessary poor outcomes associated with sepsis.

The regional maternity sepsis screening tool can be found as part of Guideline SWBH/MAT/108: Sepsis in Obstetrics early detection, identification and treatment.