Using improvement methodology to increase patient safety and harm free care


A team of Patient Deterioration Nursesat Newcastle Hospitals have led on a QI project, known at ALERT, that aims to improve the recognition of sepsis – to ensure timely treatment and ultimately save lives.

Sepsis is a life-threatening reaction to an infection that can often be extremely difficult to identify, with symptoms often suggesting less serious illnesses. Whilst there are a number of guidelines in place, sepsis is a medical emergency that is reliant on timely diagnosis and prompt treatment.

The team therefore set out on an improvement project that would reduce delays in recognition, escalation and treatment. It also sought to diminish any preventable deaths from sepsis.

Driver Diagrams

The first stage in the improvement project was to create a plan by producing two Driver Diagrams.

The first diagram focused on improving compliance rates for recognising and escalating deteriorating patients by 20% in four months. This aimed to:

  • Ensure patient deterioration is recognised and escalated appropriately
  • Make sure deterioration documentation is completed accurately, including sepsis screening

Using the driver diagram the team identified the need to ensure observations were taken and recorded accurately. It also highlighted an educational element – to ensure staff knew who to inform about the clinical presentation of patients and how to record this correctly, as well as how to escalate and how to contact them. Staff needed to be very well educated on how to use deterioration documentation, so it should be accessible and easy to use.

Their second driver diagram looked at improving rates of sepsis screening by 20% in four months as well as improving the overall sepsis antibiotic administration within one hour of diagnosis of sepsis. It reviewed:

  • Screening of septic patients
  • Prompt diagnosis of sepsis followed by administration of antibiotics in one hour

This diagram highlighted the need to ensure patient vital observations were completed accurately and recorded correctly. It also showed that staff need to know how to identify septic patients using NEWS2 and red flags, but also how to highlight this to an appropriate clinician for senior review, to timely prescribe antibiotics.

The two driver diagrams led the team to develop a clear set out plan, that included:

  • Selecting wards that would benefit most
  • Visiting wards to assess baseline
  • Issuing questionnaires to review the knowledge and current use of the Deterioration ALERT system – as well as barriers and areas to focus on
  • Implementing education and bespoke training. This included using case studies specific to areas
  • Feeding back to areas for improvement

PDSA cycles

The Patient Deterioration Nurses also used PDSA cycles to carry out their activities, including the following example for their questionnaires:

  PLAN: develop baseline understanding of how sepsis screening, eObs and deterioration alerts / escalation are used and perceived currently on wards and barriers for compliance   DO: Release deterioration and sepsis staff questionnaire   STUDY: collate feedback and extract themes to identify areas of good practice and for improvement   ACT: Proved tailored education sessions to wards and address feedback when possible  


Following the QI project there have been a number of improvements made:

  • Great staff feedback from education sessions
  • Staff engagement
  • Staff reported increased confidence in role
  • Staff open and honest and wanted to make improvements
  • Nursing compliance improved
  • Better documentation of escalations