Hospital did not have full guidelines on sepsis

Galway University Hospital did not have a hospital-wide guideline in place for the management of sepsis in adult patients, despite treating well over 100 such cases a year, the Health Information and Quality Authority report found.

It said the hospital reported that 167 maternity and non-maternity patients in total required ICU care as a result of sepsis in 2011, and 139 patients required this care in 2012.

“The hospital also reported that 70 patients required High Dependency Unit (HDU) care as a result of sepsis in 2011, while 89 general patients required such care in 2012,” it said.

“Despite this, the authority found that at the time of the investigation, the hospital did not have a hospital-wide guideline in place for the management of sepsis in adult patients.

“Furthermore, it found that there was no consistent definition of sepsis, severe sepsis and septic shock in use across UHG.”

However, the hospital had a guideline in place for the management of “suspected sepsis and sepsis in obstetric care”. However, the clinical governance arrangements were not robust enough to ensure adherence to this guideline.

In addition, clinical staff had not received specific sepsis training in relation to the application of this policy and/or the specific management of a maternity patient with sepsis.

Hiqa’s report says women with maternal infection can deteriorate rapidly from sepsis to severe sepsis and then into septic shock.

However, when the authority examined the evidence available for the recording of maternal morbidity related to sepsis nationally it found there was no nationally agreed definition of maternal sepsis, and that there were inconsistencies in recording and reporting of maternal sepsis.

Safety measures
At the time of its investigation, there was also no agreed national dataset of quality and safety measures for maternity services in Ireland and no consistent approach to reporting clinical outcomes.

“The authority was significantly concerned about the absence of a national overview and structured assurance arrangements to monitor the safety and quality of maternity services in Ireland.”

The report has recommended that the HSE should develop a national clinical guideline on the management of sepsis and ensure that all hospitals put in place arrangements for formal staff training on the recognition and management of sepsis and on the clinically deteriorating patients, including pregnant women in line with the guideline.

The report said: “This guideline should incorporate an escalation/referral pathway that includes clinical, legal and ethical guidance for staff at critical clinical points and contain key elements of patient consultation and consent in respect of their treatment and associated interventions.”