This policy sets out the principles that hygeia dental care applies to the recognition and assessment of patients at risk of sepsis, plus the diagnosis and early management of sepsis and septic shock.
Sepsis is also sometimes called “septicaemia” or “blood poisoning”.
It is a life-threatening condition triggered by an infection anywhere in the body. This can include a dental or throat infection.
Normally, the immune system fights infections. However, in some cases, the body over-reacts and the immune system attacks the body’s own organs and tissues. Left untreated, it can cause organ damage and death. We don’t yet understand why this happens.
Sepsis kills over 52,000 people each year in the UK but can be successfully treated if diagnosed early: it is estimated that 14,000 lives could be saved every year with early diagnosis (source: UK Sepsis Trust).
Some people are more at risk of developing sepsis, such as the very young or very old, people with diabetes, people who are immunocompromised, etc.
assessing patients for sepsis risk
The UK Sepsis Trust publish “Decision Support Tools” for primary dental care services that set out a simple flow-chart process for assessing patients. The appropriate flow-chart depends on the age of the patient:
- flow chart for people aged 12 years and over,
- flow chart for children and young people aged 5-11 years, and
- flow chart for children aged under 5 years.
Rather than produce our own detailed protocols, we use these flow-charts to assess patient risk. Links to each of these flowcharts have been placed on the desktop of each practice computer (surgery 1 and 2, reception and both office machines) so that they are immediately accessible to all team members.
When a patient attends the practice with a potential dental infection, they are assessed using a pro-forma (see code EANTIBIOTIC) that is intended to determine whether a prescription for antibiotics is indicated and includes checks of their vital signs and consideration of possible sepsis indicators. It also grades patients as low, medium and high risk (grade 1, 2 and 3 respectively) and prescribes appropriate action (ranging from telephone follow-up to urgent referral to MaxFax on-call SHO to urgent hospital admission by ambulance).
If any “Red Flags” are present, reassure the patient but CALL 999 and request an ambulance immediately clearly stating that this is a Red Flag sepsis case.
If an “Amber Flag” is present, we will first seek to treat/deal with any potential source of infection and give “safety netting” advice so that the patient knows to seek help should they develop symptoms or find that their condition deteriorates.
The patient information that we provide includes “safety netting” advice. It gives emergency contact information for the practice – the landline number is answered 24/7, plus the personal mobile number for the dentist is included. Patients are advised to contact the practice for advice immediately should they notice a deterioration in their condition. The relevant patient information includes our Antibiotics Advice, Pain Control Advice, Post-Root Canal Treatment Advice and Post-Extraction Advice – all of which apply to circumstances where an infection is likely to be involved and may indicate a sepsis risk.
Team members receive training on recognition of the symptoms of sepsis and initial management as part of our regular medical emergencies training, including role-play based examples.
In addition, team members receive annual in-house training on sepsis, with emphasis on how we identify and manage sepsis risk in accordance with this policy and where to find information on sepsis at the practice should the need arise.
Team members can find more detailed information in the guideline “Sepsis: recognition, diagnosis and early management” published by the National Institute for Health and Care Excellence (NG51).
Web version 2: 10.3.2019
Previous web versions: 17.8.2018 (reviewed 11.11.2018)