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PLD.42 ‘Sepsis Six’ – Adaptation of a trust innovation in Maternity
  1. L Deutsch,
  2. R Aggarwal,
  3. A Wright,
  4. C Stapleton,
  5. S Stanley,
  6. M Emerson
  1. Royal Free Hospital, London, UK

Abstract

Introduction Sepsis was the leading cause of maternal death in the 2006–2008 Confidential Enquiry, 1 which led the development of the RCOG Guideline recommending early treatment to reduce morbidity and mortality.2 Following a death from severe sepsis at the Royal Free Hospital in 2009, the ‘Sepsis Six’ Protocol was designed and implemented by the Trust Board. An 8% reduction in mortality, with 20% increased survival secondary to sepsis3 in other hospital departments, inspired adaptation of this protocol for Maternity in October 2013.

Intervention Patients requiring implementation of ‘Sepsis Six’, trigger if two or more objective parameters are abnormal (Temp <36°C or >38°C, SBP < 90 mmHg; HR ≥ 125 bpm; RR ≥ 25 bpm, GCS < 15; Oliguria (<0.5 ml/kg over 2 h); pH < 7.25; lactate > 4). This prompts a care package of six management steps (oxygen, IV antibiotics, IV fluid challenge, septic screen, venous lactate, fluid balance monitoring). A multi-disciplinary team adapted ‘Sepsis Six’ for obstetric patients to include recognition of obstetric sources of sepsis, restricted fluid resuscitation for pre-eclamptic women and introduction of an obstetric antibiotic guideline.

Results Since implementation, ten patients have met criteria for initiation of ‘Sepsis Six’ management; 50% achieved all interventions within one hour. All women were managed appropriately by the multi-disciplinary team and discharged home.

Conclusion This pilot reflects lessons learnt from elsewhere in the hospital can lead to innovations in maternity. In the future, we hope to emulate the >95% compliance for initiation of interventions within one hour, which has been achieved in other areas of the hospital.

References

  1. Centre for Maternal and Child Enquiries (CMACE). Saving Mother’s Lives: reviewing maternal deaths to make motherhood safer: 2006–2008 BJOG 2011; 118(suppl. 1): 1–203 London: RCOG Press; 2007

  2. Royal College of Obstetricians and Gynaecologists Green Top Guideline No 64A: Bacterial Sepsis in Pregnancy, 1st edition, April 2012

  3. Severe Sepsis Improvement Group, Royal Free Hospital, data review 2009–2013 (Jan 2014)

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