Sepsis Six – update for end of life care in community
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Sepsis Six – update for end of life care in community

Erin Dean Health journalist

The UK Sepsis Trust and Marie Curie’s new version of the Sepsis Six tool helps nurses in the community to assess risk to patients and guide decision-making

A new version of the well-known Sepsis Six tool has been developed for nurses giving end of life care in the community. The tool is a collaboration between the UK Sepsis Trust and end of life charity Marie Curie.

Primary Health Care. 33, 3, 11-11. doi: 10.7748/phc.33.3.11.s5

Published: 30 May 2023


Picture credit: iStock

The tool for adults will help all nurses in the community to assess a patient’s risk of sepsis, which is the immune system’s overreaction to an infection or injury, and guide their next steps. If not treated immediately, sepsis can result in organ failure and death.

High-risk group

Patients receiving end of life care are a high-risk group for sepsis. Many people who develop sepsis have underlying medical conditions, and a significant proportion are living with frailty or approaching the end of natural life, the UK Sepsis Trust says.

Compared to the standard community nursing Sepsis Six tool, the new end of life care tool has greater reinforcements and considerations about the appropriateness of escalation for patients at end of life.

‘The fundamental steps of the Sepsis Six remain the same, and start with ensuring a senior clinician with skills in caring for those with sepsis is involved in the decision-making process,’ says UK Sepsis Trust lead support nurse Oliver Jones.

The Marie Curie end of life version starts by asking the user to consider if a patient could have a new reversible illness, and if it may be caused by infection. If not, the clinician is prompted to think about whether the symptoms are a sign the patient is actively dying.

If an infection could be the issue, consider if acute hospital assessment would be appropriate. Checking whether there is an advance care plan and asking their family about the patient’s expectations can inform this decision, the tool says.

If hospital assessment is deemed inappropriate, the nurse should call the GP or on-call clinician for advice and consider arranging an assessment. The tool stresses that active community care could still be appropriate in this situation.

If hospital care is an option, nurses should check whether the patient has one or more new symptoms from the eight sepsis ‘red flags’ listed:

  • » Abnormal mental state.

  • » Being less active.

  • » Being unable to catch their breath or speak.

  • » Very fast breathing.

  • » Skin that is pale, mottled, ashen or blue.

  • » A non-blanching rash.

  • » Recent chemotherapy.

  • » Not having passed urine in the past 18 hours.

If a patient has at least one of these, the nurse is urged to dial 999 for a blue-light transfer to hospital.

If none of these signs are present, routine care should continue, with a call to the GP or 111 if their condition deteriorates.

Ensuring most appropriate treatment

This tool is designed to enhance identification of sepsis in the community for people receiving end of life care, and ensure they receive the most appropriate treatment.

The pathway gives professionals a prompt so that if care is not escalated to an acute setting, those patients who require active treatment can still receive the best possible care in the community setting, the UK Sepsis Trust says.

‘While we acknowledge that escalation of care to an acute hospital or invasive treatment may not always be appropriate or in the person’s best interest, some people do and will have a potentially reversible illness,’ Mr Jones says. ‘These important steps are highlighted at the start of the pathway.’

Marie Curie chief nurse Julie Pearce says that someone with a terminal diagnosis will be living with that diagnosis for a period of time and will experience symptoms that need to be managed. ‘The result of using this tool for people with any terminal illness, including cancer, is they will have more quality time with the people who are important to them right up until the end of life.’

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