PA.41 A maternity focused sepsis tool: improving the recognition and management of sepsis in obstetric care

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Abstract

Introduction

Sepsis is the leading cause of direct maternal mortality, resulting in 27 deaths in the UK between 2006 and 2008:1 in 70% of these cases, CMACE identified substandard care.1 The Surviving Sepsis campaign supports early recognition and treatment of sepsis, and improved survival by implementing six evidence based management steps in non-pregnant populations.2 However, this is not widely used in obstetric care. We aimed to develop and implement a tool utilizing the physiological and biochemical parameters of pregnancy, whilst identifying the clinical features that should raise suspicion of sepsis in this vulnerable group of patients.

Methods

Using a trust-wide Sepsis Screening tool, we developed a maternity specific tool. We implemented this throughout our department, and refined it using Plan-Do-Study-Act (PDSA) cycles. Multi-professional education sessions were provided, underlining the importance of prompt management. A retrospective monitoring checklist was devised to audit compliance.

Results

Initiation of the bundle between November 2012 and November 2013, improved from 38.5% (5/13 patients) to 100% (13/13 patients). At the beginning of the study only 1/5 women (20%) received the complete bundle within 1 h1 hour, compared to 9/13 (69.2%) in November 2013.

Conclusion

The use of a maternity specific sepsis tool prompts early recognition and treatment. We believe our proforma, and ongoing monitoring tool, has raised the profile and awareness of sepsis within our department, resulting in a reduction in time for instigation of the complete bundle. This should result in a reduction in morbidity and mortality in the pregnant population.

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