Sepsis is a serious condition, with significant medicolegal risk. Dr Pallavi Bradshaw, Education Services Lead at Medical Protection, looks at where the risk lies
Sepsis, sometimes referred to as the ‘silent killer’, claims several million lives per year worldwide and is associated with seven deaths per day in Irish hospitals. Despite these figures, a 2018 poll found that 72% of people were not aware of sepsis.3
Over the years at Medical Protection, we have seen thousands of cases related to sepsis, with a poor outcome resulting in action being taken against the institutions and healthcare workers involved.
Where the risk lies
Those particularly at risk include newborns, young children, pregnant women, the elderly and those with a compromised immune system or existing chronic illness. Those who have had surgery are also at more risk of sepsis.
Problems with sepsis stem from delays in its early identification, particularly in the community, and delays in senior review in secondary care and implementing treatment early. A lack of general awareness, education, training and appropriate local protocols are thought to contribute significantly to this delay in diagnosis and treatment.
Early on in the disease, symptoms and signs can be subtle and non-specific, and therefore it is difficult to diagnose. Internationally, early recognition and timely referral have reduced sepsis mortality by 20–30%.
Not only can sepsis result in significant physical disability and death, but it can also result in the even lesser-known post-sepsis syndrome, in which patients can experience weakness, malaise, pain, anxiety, poor sleep and concentration. Those who are admitted to intensive care are more at risk of this syndrome.
When faced with a potential case of sepsis, the usual medicolegal advice applies:
• Take a comprehensive, detailed history.
• Carry out a thorough examination and, where the patient is a child, bear in mind the concerns of the parents – even if visible signs are subtle, parents know their child better than anyone and are often a reliable indicator of when something is wrong.
• Ensure good communication, both verbal and non-verbal, to keep the patient and relatives fully informed in a clear, controlled manner.
• Document the findings, possible diagnosis and discussions with the patient, including ‘safety-netting’ advice given to the patient about when to seek more urgent review.
If referring the patient to another healthcare team, the importance of good record-keeping and handover to secondary care is essential. Ideally this should cover:
• relevant medical history
• examination and other relevant clinical findings – include important positives and negatives, and details of objective measurements such as blood pressure
• differential diagnosis
• investigations – details of any investigations requested
• treatment – details of drugs, doses, amount prescribed and any other treatment organised (include the batch number and expiry date of any medications personally administered)
• past medical and medication history.
So what more can be done? The HSE urges everyone to consider “Could it be sepsis?, since early recognition saves lives. The National Clinical Guideline has adapted international guidelines to align with the Irish healthcare system to inform care pathways for all Irish medical disciplines to use. It is also recommended that if you have considered sepsis and carried out an assessment that this is recorded along with safety-netting advice, including what to look out for and how to get help.
Learning from cases
Medical Protection has always been a strong advocate for improving patient safety and is dedicated to equipping doctors with the skills and knowledge to achieve this. As part of this, you can read two case reports on our website that revolve around missed signs of sepsis: “Concealed sepsis
” and “Sepsis following chemotherapy
 World Health Organization, Sepsis. Available from: who.int/news-room/fact-sheets/detail/sepsis
 NCEC, Sepsis Management National Clinical Guideline No. 6 2014. Available from: hse.ie/eng/services/publications/clinical-strategy-and-programmes/guideline-no-6-summary-document.pdf