163 Sepsis audit results in the implementation of a NEWS 2 scoring system in the hospice inpatient setting

<h3></h3> Sepsis is a life-threatening condition, and palliative care patients are exceptionally vulnerable. Patients receiving care in the hospice are often complex and may be in the last hours to days of their life. This makes the recognition and decisions around investigating and managing deterioration challenging. Therefore, Wirral Hospice St John’s (WHSJ) implemented a sepsis policy considering NICE guidance, which, unlike the acute setting, does not include routine observations and scoring systems. This audit aims to review whether the recognition and management of sepsis at WHSJ meet the standards outlined in the local sepsis policy. A retrospective electronic case-note audit of all patients who received intravenous (IV) antibiotics on the WHSJ inpatient unit between September 2023 and August 2024 was conducted. Patients meeting the criteria to indicate the presence of sepsis were identified, and their case notes were analysed against standards from the WHSJ sepsis policy. 27/56 patients who received IV antibiotics met the sepsis criteria. 4 had alternative explanations, therefore 23 patients were included. 8/23 (35%) of patients meeting the criteria for sepsis had a diagnosis documented. 3/23 (13%) of patients had blood cultures taken, 15/23 (65%) had antibiotics within an hour. 21/23 (91%) of patients had no plan for observations documented, with 18/23 (78%) receiving observations once daily or less frequently. A limitation is that patients who did not receive IV antibiotics were not included. 35% of patients waited over an hour for antibiotics, which is an area for improvement. Observation frequency post-recognition of sepsis was variable, with most patients not having a plan documented, perhaps due to the lack of routine observations in the hospice setting. Therefore, WHSJ will develop a sepsis protocol that involves implementing a NEWS 2 scoring system, with the aim of improving sepsis management in the hospice inpatient setting.