Quality standard

Quality statement 4: Assessment and antibiotic treatment for suspected sepsis

Quality statement 4: Assessment and antibiotic treatment for suspected sepsis

Quality statement

Pregnant women in labour with suspected sepsis have an immediate assessment by a senior clinical decision maker and antibiotics given within 1 hour if indicated.

Rationale

Physiological changes during labour may mask the early signs of sepsis. Sepsis is a medical emergency and needs immediate assessment from a senior clinical decision maker. The team determines whether antibiotics are needed as part of initial management, and they should be given within 1 hour of sepsis being suspected, if needed. Sepsis is associated with maternal and neonatal mortality. Unwarranted antibiotic treatment may, however, pose an unnecessary risk to the unborn baby, so senior assessment before prescribing is important.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to support escalation protocols to ensure that pregnant women in labour with suspected sepsis are transferred from home birth and midwifery-led units to an acute setting for assessment and to start antibiotic treatment (if indicated) within 1 hour.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local network agreements and transfer protocols.

b) Evidence of local arrangements to ensure availability of, or access to, a senior clinical decision maker for pregnant women in labour with suspected sepsis to have an immediate assessment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local network agreements, transfer protocols and staff rotas.

c) Evidence of local arrangements to start antibiotic treatment, if indicated, for pregnant women in labour with suspected sepsis within 1 hour.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from maternity records.

d) Evidence of local arrangements to document the decision to start antibiotic treatment for pregnant women in labour with suspected sepsis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from maternity records.

Process

a) Proportion of pregnant women in labour with suspected sepsis who have an immediate assessment by a senior clinical decision maker.

Numerator – the number in the denominator who have an immediate assessment by a senior clinical decision maker.

Denominator – the number of pregnant women in labour with suspected sepsis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from an audit of maternity records.

b) Proportion of pregnant women in labour with suspected sepsis who started antibiotics within 1 hour.

Numerator – the number in the denominator who started antibiotics within 1 hour.

Denominator – the number of pregnant women in labour with suspected sepsis who needed antibiotics.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from an audit of maternity records.

c) Proportion of pregnant women in labour with suspected sepsis who had the rationale for the decision to start antibiotics documented.

Numerator – the number in the denominator who had the rationale for the decision to start antibiotics documented.

Denominator – the number of pregnant women in labour with suspected sepsis who had antibiotics.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from an audit of maternity records.

What the quality statement means for different audiences

Service providers (NHS hospital trusts) ensure that protocols, systems and pathways are in place for pregnant women in labour with suspected sepsis to have an immediate assessment by a senior clinical decision maker and receive the first dose of antibiotics, if indicated, within a 1-hour timeframe. They also ensure that protocols are in place to document the rationale for the decision to start antibiotics.

Healthcare professionals (clinicians grade ST3 or above or equivalent) assess pregnant women in labour with suspected sepsis immediately. They decide whether to give antibiotics based on this assessment, and administer the first dose of antibiotics, if indicated, within the 1-hour timeframe. They also document the rationale for the decision to start antibiotics.

Commissioners ensure that they commission services that have protocols, systems and pathways for pregnant women in labour with suspected sepsis to have an immediate assessment by a senior clinical decision maker and antibiotics given within 1 hour, if indicated. They also ensure that services have capacity to perform the assessment and have protocols in place to document the rationale for the decision to start antibiotics.

Pregnant women with suspected sepsis are assessed by a senior healthcare professional as soon as sepsis is suspected. As part of this assessment, a decision is made about whether antibiotics are needed, and if they are, they are started within an hour.

Definitions of terms used in this quality statement

Senior clinical decision maker

A 'senior clinical decision maker' for people aged 18 years or over is a clinician of grade ST3 or above or equivalent. The senior decision-maker for people under 18 is a clinician of grade ST4 or above or equivalent. [Adapted from NICE's guideline on suspected sepsis, terms used in this guideline]