Journal of Community Nursing

22 JCN 2020,Vol 34, No 4 recognition of early symptoms is often missed by healthcare professionals. The guideline acknowledges this and states: Ensure all healthcare staff and students involved in assessing people’s clinical condition are given regular, appropriate training in identifying people who might have sepsis. This includes primary, community care and hospital staff, including those working in care homes. The clinical need dictates that this guideline must be enacted locally, as the responsibility lies with all healthcare professionals, regardless of clinical setting. What then needs to happen if these human and financial costs are to be reduced? The parliamentary ombudsman report (PHSO, 2013) offered the following simple acronym for recognition of sepsis:  S lurred speech  E xtreme muscle pain  P assing no urine  S evere breathlessness  I feel that I might die.  S kin mottled or discoloured. This is a useful starting position for anyone involved in patient care. The key features to be observed and measured are temperature, pulse, blood pressure, and respiration rate ( Table 1 ). These features are quick, simple to observe with minimal training, and will save lives if patients are hospitalised immediately. Sepsis should be regarded as equivalent to stroke or heart attack in terms of clinical urgency. The Royal College of Physicians (RCP) has devised a similar system, which is denoted as NEWS (national early warning score; now updated to NEWS2). This involves six simple physiological parameters, which form the basis of the scoring system: 1. Respiration rate F ew healthcare professionals, if any, cannot be unaware of sepsis and its clinical consequences. Publicity surrounding sepsis, initiated in no small way by the UK Sepsis Trust (sepsistrust. org), has used the shocking data on morbidity and mortality to bring a closer focus on the problem. This brief editorial review is aimed at providing an essential introduction to the basics of recognition and the urgent actions related to suspicion of sepsis, and some of the essential links to resources and guidelines aimed at early detection. A subsequent article will cover the lived experience of recovering patients post-sepsis in an attempt to highlight the pressing ongoing social and healthcare needs. In 2013 the NHS identified sepsis management as a clinical priority. Sepsis is defined as a SIRS (systemic inflammatory response) initiated by infection. It is no longer to be called septicaemia and is not an infection per se. In the UK, NHS statistics show that sepsis incidence and mortality has been increasing dramatically (Parliamentary and Health Service Ombudsman [PHSO], 2013). Reasons given for this include:  Failure of early recognition  Antibiotic resistance  Increased bacterial virulence  An ageing population. The economic burden is similarly high, making improvement in diagnosis and care clinical priorities. Gaps in care delivery have also been identified and there is evidence of a huge opportunity for cost-effective quality improvement (Cecconi et al, 2018). Sepsis is documented as the direct cause of death in at least 200,000 episodes annually, with up to 52,000 deaths in the UK for the year 2018–19 according to NHS data published by the UK Sepsis Trust (Sepsis Trust, 2020). Sepsis claims more lives than breast, bowel and prostate cancer put together. The literature attributes many cases to urinary and respiratory tract infections; all skin wounds (even minor and seemingly innocuous wounds such as scratches can lead to sepsis) and ulcers, including surgical wounds, pressure ulcers and the diabetic foot, are also sources of many cases (White and Witts, 2016). Currently, the emergence of Covid-19 disease has been intimately linked with sepsis (White, 2020). The financial cost of sepsis to the UK has been calculated by the York Health Economic Consortium (YHEC). According to the published report,‘the estimated costs of sepsis each year in the UK are £7.76 billion, including approximately £830 million of direct costs. Applying sensitivity analysis to these costs (higher hospital costs and lower estimate of average age of death from sepsis for adults of working age) would give an estimated annual cost of more than £10 billion, including more than £1.1 billion of direct costs’(YHEC, 2017). The National Institute for Health and Care Excellence guideline on sepsis (NICE, 2016) is of great significance to all involved in patient care. The mortality rate associated with sepsis is so high (almost 25% of all cases diagnosed will die from the disease and its complications (Fleischmann et al, 2016), that it is reasonable to assume that Sepsis: the essentials Viewpoints Richard White, professor of tissue viability, DDRCWound Care, Plymouth