Nova Scotia Health works to speed up sepsis treatment

Nova Scotia Health is equipping front-line caregivers in some of the province's emergency rooms with potentially life-saving tools to treat sepsis.

A team has been working to implement changes to enable a faster response when people present with sepsis symptoms.

Sepsis is caused by the body's overreaction to an infection that is already present. Cases have been on the rise for the past few decades, according to Sepsis Canada.

Recommendations from the health authority's own reviews into patient care are cited as factors for the changes.

"Sepsis is a very real issue in our province," said Dr. Vanessa Sweet, the central zone sepsis team co-lead. "It was clear to us that we needed to take a different approach to it."

The team examined the approaches of other health systems that have made progress in the area to then bring some of those ideas to the front lines of emergency care in Nova Scotia.

One thing the group developed are sepsis treatment kits that include all the supplies needed to act fast.

"And it has proven that way, I've seen these used many times, people are grabbing for them, instead of having to go pull things and getting pulled to different situations," said Terri McGregor, a registered nurse at Twin Oaks Memorial Hospital in Musquodoboit Harbour.

Inside the ready-to-deploy boxes are blood-testing equipment, intravenous fluid supplies and tourniquets along with requisition forms and detailed instructions. 

Nurses now administer life-saving antibiotics 

Another key new care directive allows nurses to begin antibiotic treatment without approval from a physician.  

"If we had no physician on site, say, they're getting those antibiotics immediately," McGregor said.

"This lets nurses work to their full scope of practice," said Sweet. 

Twin Oaks, Cobequid Community Health Centre in Lower Sackville and Hants Community Hospital in Windsor began implementing the changes in the first phase of the project.

"Now over 90 per cent of patients at the three sites are receiving their antibiotics within the three-hour recommended time frame," Sweet said. 

"We've seen a drastic improvement in that," she said, adding the previous number was around 60 per cent.

The program has since grown to include six hospitals, according to Nova Scotia Health.

'Every hour is absolutely essential'

Detecting and treating sepsis early can be the difference between life and death, said the scientific co-chair of Sepsis Canada.

"We know from the literature that every hour that someone is in severe sepsis and they're not getting appropriate treatment, their chance of dying goes up by 10 per cent," said Dr. Osama Loubani, who is also an emergency room physician in Halifax. "Every hour is absolutely essential."

Karen Moxsom from Hardwood Lands in central Nova Scotia saw how fast sepsis can take hold when her husband got sick.

A quality review of 74-year-old Gordon Moxsom's case was conducted after he died just over two years ago. 

At the time, his wife had not even heard of the condition. 

"There's not enough awareness out there for sepsis, it can happen so quickly. It's one of the top leading killers with cancer, with heart attacks," said Moxsom. "Nobody knows anything about it."

She still maintains her husband may not have contracted sepsis had he not been discharged from the QEII Health Sciences Centre in Halifax with a catheter — where she thinks the infection started — following treatment of earlier heart problems.

Included in the review is Moxsom's complaint that she did not receive proper guidance following her husband's discharge about how to monitor for infection, or any education about sepsis symptoms. 

She's still pushing for answers about his care and is encouraged to see there is further action to improve treatment.

"I'm happy that they are doing it. I was glad to see that because I feel like I was a part of that by reporting what happened to Gordie."

Moxsom now wants to see the changes implemented provincewide, which is something the action improvement team is now looking at as it attempts to scale up its work.

The Halifax Infirmary is scheduled to start in the fall. A provincial rollout is planned after that.