PA.41 A maternity focused sepsis tool: improving the recognition and management of sepsis in obstetric care

Abstract

Introduction Sepsis is the leading cause of direct maternal mortality, resulting in 27 deaths in the UK between 2006 and 2008:1 in 70% of these cases, CMACE identified substandard care.1 The Surviving Sepsis campaign supports early recognition and treatment of sepsis, and improved survival by implementing six evidence based management steps in non-pregnant populations.2 However, this is not widely used in obstetric care. We aimed to develop and implement a tool utilizing the physiological and biochemical parameters of pregnancy, whilst identifying the clinical features that should raise suspicion of sepsis in this vulnerable group of patients. Methods Using a trust-wide Sepsis Screening tool, we developed a maternity specific tool. We implemented this throughout our department, and refined it using Plan-Do-Study-Act (PDSA) cycles. Multi-professional education sessions were provided, underlining the importance of prompt management. A retrospective monitoring checklist was devised to audit compliance. Results Initiation of the bundle between November 2012 and November 2013, improved from 38.5% (5/13 patients) to 100% (13/13 patients). At the beginning of the study only 1/5 women (20%) received the complete bundle within 1 h1 hour, compared to 9/13 (69.2%) in November 2013. Conclusion The use of a maternity specific sepsis tool prompts early recognition and treatment. We believe our proforma, and ongoing monitoring tool, has raised the profile and awareness of sepsis within our department, resulting in a reduction in time for instigation of the complete bundle. This should result in a reduction in morbidity and mortality in the pregnant population. References Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the UK. BJOG 2011;118 (Suppl. 1):1–203 Society of Critical Care Medicine. Surviving Sepsis Campaign. [Online] Available from: [Accessed 10thJanuary 2014]