Identifying sepsis in haematology patients

Sepsis is a rare and very serious reaction to an infection, but it can be hard to identify. We caught up with Sarah Casboult, Simon Slade, James Manns, and Kelly Brockman from the Advanced Clinical Practitioner team at King's College Hospital NHS FT to find out more about the condition and how it affects people with haematological conditions. 

What is sepsis? 

Sepsis is a serious condition in which the body’s immune system has an extreme response to an infection. There is a dysregulated host response which is associated with organ dysfunction and increased risk of death (The National Institute for Health and Care Excellence (NICE), 2020). Signs and symptoms of sepsis include fever, hypotension, tachycardia and confusion. 

Sepsis is extremely important within haematology, as these patients are considered a high-risk patient population, with a higher risk of sepsis, due to their immunosuppressed state. Due to disease or treatments including chemotherapy, a large proportion of our patients are neutropenic with an absolute neutrophil count of <0.5 x109/L. Neutropenic sepsis is a potentially life-threatening complication of neutropenia and should be treated as a medical emergency (NICE, 2020).  

Management of sepsis should include the implementation of the ‘Sepsis Six’ bundle including the aggressive use of intravenous antibiotic therapy within the first hour of recognition.  

What roles do the Advance Clinical Practitioner team play when caring for sepsis patients? 

Advanced clinical practice (ACP) is characterised by a high degree of autonomy and complex decision making, encompassing the four pillars of clinical practice, leadership and management, education, and research (Hypotonic-hyporesponsive episode (HHE), 2017).  

Within the haematology department here at King’s College Hospital NHS FT, there is a team of four ACPs all with different clinical backgrounds and expertise. While all four ACPs have a nursing background, they bring a wealth of experience from different specialities including haematology, emergency and acute medicine and intensive care and critical care outreach. 

As a vital part of the multi-disciplinary team, ACPs are often the first responders to review patients, form a diagnosis and initiate treatment, including the prescribing of antibiotics and fluids. They provide continuity of care and work collaboratively with other teams across the trust. 

ACPs also deliver educational sessions on sepsis to the ward nursing staff, with the aim to improve recognition and treatment, highlighting the importance of the ‘Sepsis Six’ bundle and the initiation of starting antibiotics within the first hour. They play an important role in developing and updating clinical guidelines for example the Patient Group Direction (PGD) for the supply and administration of Piperacillin with Tazobactam for the treatment of sepsis, with the aim to facilitate in the delivery of antibiotics within one hour of recognition of sepsis. ACPs also play an important role in the audit cycle, ensuring care delivered is in line with national standards, and highlighting where improvements could be made. 

ACPs play a vital role in patient and family education. Due to their continuity, they can build a good rapport with patients throughout their treatment. Early recognition of sepsis and prompt initiation of treatment is essential to reduce morbidity and mortality. It is crucial to educate patients and their family on the signs of sepsis, what to monitor or look out for and when to contact their medical team or visit to the emergency department.  

What can other clinical and healthcare professionals do to support sepsis management? 

Any healthcare professional can alert a member of the medical team for review if they are concerned or worried about a patient. The key to improving patient outcomes from sepsis is early identification and prompt treatment. Therefore, it is critical that all healthcare professionals, patients and the public are aware of the signs and symptoms of sepsis. 

Find out more about the work of KHP Haematology.   

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