Do your Pharmacy Support Staff Just Ask: Could it be Sepsis?

MediaPharm’s Sepsis Awareness Training Course

MediaPharm provides sepsis awareness training to help spot the signs of this rare but potentially deadly condition. This training course will help you and pharmacy team spot the signs and help saves lives.

Access the FREE sepsis awareness training here or read on for more information.

Sepsis focus

Sepsis is rare but can kill. Catching sepsis early can, therefore, save lives.

There are around 123,000 cases of sepsis in this country each year with approximately 37,000 deaths. This is more than breast, bowel and prostate cancers combined, according to NHS figures. In addition:

25,000 children are affected by sepsis each year
A quarter of all sepsis survivors suffer permanent life-changing after-effects
5 people are killed by sepsis every hour

With 70% of sepsis cases occurring within primary care, identifying and managing sepsis in pharmacy is an important step in reducing deaths.

The pharmacy context

Sepsis can progress quickly from being a mild condition to being a serious life-threatening one. For that reason, community pharmacy is being asked to take a more proactive role in the community by helping identify the early signs in people visiting the pharmacy and directing them to A&E.

To formalise this, the Pharmacy Quality Scheme (as part of the pharmacy contract) now expects pharmacists and pharmacy technicians to be trained in recognising sepsis and in ensuring the whole pharmacy team picks up on alert symptoms and refers appropriately to the pharmacist.

Understanding sepsis

Sepsis (also referred to as blood poisoning) is the body’s abnormal immune reaction to infections that have got into the body, for example from infected cuts or bites, urine infections and chest infections. Most cases are caused by common microbial infections (bacterial, viral, fungal) that people normally come across without any harm; it’s on rare occasions that the body goes into over-drive leading to sepsis and sometimes shutting down the normal function of organs.

Who does it affect?

It is not known why the body responds abnormally to infections and leads to sepsis. According to the UK Sepsis Trust, people are more likely to develop sepsis after a viral illness (e.g. cold or flu) or an injury. However, it has identified the following groups as more likely to develop it than others:

Very young or very old
Those with diabetes
On long-term steroids or on drugs to treat cancer (chemotherapy)
Have had an organ transplant and are on anti-rejection drugs
Are malnourished
Have serious liver disease
Have a serious illness which affects the immune system (e.g. leukaemia)

Symptoms

Early signs are vague and mainly appear as flu-like symptoms or a chest infection. People affected may also seem confused or have slurred speech. Always ‘think sepsis’ and refer these to the pharmacist.

Be aware also that sepsis can be hard to spot in people who can’t communicate their symptoms e.g. babies, people with dementia and those with a communication or learning disability.

The symptoms differ in children and adults as shown below. Refer anyone with flu-like symptoms or anyone with established sepsis immediately to the pharmacist. Remember not to alarm the customer or patient, simply explain that the pharmacist wants to make sure it doesn’t need medical attention.

How is it treated?

Sepsis is treated in hospital with antimicrobials (that fight the original infection) and other drugs that help stabilise and manage the other symptoms e.g. blood pressure, breathlessness. In most cases, the patient recovers fully which is why it is so important to look out for early signs and refer.

Complications

In sepsis, the body’s immune system goes into overdrive as it tries to fight an infection. This can reduce the blood supply to vital organs such as the brain, heart and kidneys. Without quick treatment, sepsis can lead to multiple organ failure and death. Survivors may be left with life-changing complications such as amputated limbs.

Prevention

Sepsis cannot be prevented but the NHS suggests the following to help prevent infections that can lead to sepsis:

Keep up to date with vaccines, particularly for babies, children, older people and pregnant women
Clean and care for any wounds
Follow the instructions when taking antibiotics
Take all your prescribed antibiotics, even if you feel better
Wash your hands regularly and teach children how to wash their hands well

Engaging customers

Customers are unlikely to come to the pharmacy specifically about sepsis. They are more likely to come to the pharmacy for advice about infections they have or someone else has (e.g. a child or relative). There may even be instances of customers coming into the pharmacy for advice who do not realise they have the beginnings of sepsis. These are the people you need to be alert to and think ‘could it be sepsis?’.

Although the main purpose of this training is to get the pharmacy team to recognise sepsis and refer, the team can also help raise awareness of the condition and educate customers so that they learn to recognise it in future and seek help early for themselves or someone they know.

MECC

Making every contact count (MECC) is an approach to healthcare that encourages all those who have contact with the public to talk about their health and wellbeing. Pharmacy assistants working on the counter can make a huge difference in picking up on and referring customers with early signs of sepsis to the pharmacist. Those working with prescriptions can make sure at-risk people are aware of sepsis (e.g. those with diabetes, liver problems; those on immuno-suppressants, steroids, cancer drugs).

Brief interventions

Brief interventions are all about using opening lines that make an impact.

You need a hook – e.g. national campaign, something you noticed, something the customer has alluded to in passing. In all cases, you need to ‘Think Sepsis’.

Then you need to ASK, ADVISE, ASSIST.

Introducing the campaigns

There are a number of campaigns and initiatives that can help the pharmacy drive the message about sepsis.

‘Think sepsis’ is a Health Education England programme aimed at improving the diagnosis and management of people with sepsis. It encourages every healthcare professional to suspect sepsis first, assess the symptoms and then decide if it is sepsis or not.

Campaigns aimed at the public include:

Public Health England

Public Health England (PHE) also launched a sepsis campaign aimed at babies and children with posters and leaflets that pharmacy can use
Sepsis awareness campaigns closely relate to the PHE antibiotic resistance campaign ‘Keep Antibiotics Working’ which aims to reduce the inappropriate use of antibiotics. This preserves the effectiveness of antibiotics for life-threatening conditions like sepsis.

Teamwork

There are a number of ways the pharmacy can help with sepsis awareness. Have a chat with other members of the team to find out what the pharmacy as a whole can do and what roles and responsibilities you can individually take on board. The pharmacy may even have developed an SOP on this.

The following are examples:

Role of support staff

Medicines counter assistants will be on the frontline and customer-facing, and the first person customers come to for advice. They will also pick up on conversations about the customer’s friends or family members who may be experiencing symptoms that may indicate sepsis. Drivers visiting people in their home will also be able to look out and listen out for sepsis in conversations they may have.

Even outside work, helping people understand and recognise sepsis will help save lives.

The role of support staff may include the following:

Recognise symptoms that could potentially be the early signs of sepsis
Refer these to the pharmacist
Proactively raise awareness of sepsis in the pharmacy e.g. posters, brief interventions
Educate the public on sepsis and the signs to look out for
Signpost people to further information for future reference e.g. website, leaflets
Promote the PHE ‘Keep Antibiotics Working’ message to help keep these effective for treating sepsis

Role of pharmacist

The role of the pharmacist may include the following:

Ensure all support staff know what signs to look for
Ensure all support staff know to refer immediately all suspected cases of sepsis to the pharmacist so they can take responsibility for that patient
Create an SOP on referral so this is robust and consistent
‘Think sepsis’ and assess each referral from the support team and act appropriately e.g. refer to A&E or call 999
Use MUR/NMS to identify at-risk patient groups and target them with a flyer or advice on recognising sepsis and getting medical treatment
Use the PMR to target these patients proactively
Outreach – communicate the message outside the pharmacy e.g. care homes, mother and baby group, retirement groups, long-term conditions local charities

Putting learning into action

Speak to your colleagues about how each person in the pharmacy can help customers and patients with sepsis
Refer to your pharmacy’s SOP
Look out for the signs and symptoms of early and established sepsis and refer to the pharmacist
Familiarise yourself with the health promotion messages of the campaigns and initiatives
Make every contact count and promote sepsis awareness to your customers

Sepsis Awareness Training for Pharmacy Support Staff

Mediapharm‘s sepsis awareness training course has everything you and your team need to spot the signs of sepsis and ask “Could it be Sepsis?”.