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{"sheet":"Introduction","index":0,"n_rows":17,"n_cols":2,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
[]
[null,"Just Say Sepsis!"]
[null,"Audit Toolkit"]
[]
[null,"Thank you for downloading the toolkit for 'Sepsis: Just Say Sepsis!\"'. We hope you find this useful and if you have any feedback please do contact us at info@ncepod.org.uk (see below for link). Please can you advise your local audit department if you plan to undertake this audit, it is important that they are made aware of it for the benefit of demonstrating Trust activity and also so that they are in a position to support you and endorse the activity for your benefit."]
[]
[null,"info@ncepod.org.uk"]
[]
[null,"Please complete as many questions which are applicable to the care of the patient"]
[]
[null,"For information on the recommendation to which each question assesses please click on the         button"]
[]
[null,"This toolkit can be used in conjunction with the Self Assessment Checklist. This can be found by clicking on the report image or at "]
[null,"http://www.ncepod.org.uk/2015sepsis.html"]

{"sheet":"Instructions","index":1,"n_rows":36,"n_cols":1,"rows_kept":36,"cut":false,"hidden":false,"merged":[[4,0,5,0]]}
["Instructions for completion"]
[]
["Before you begin, in order to fill this tool in properly you MAY need to enable macros. To do this please click on the options button above this spreadsheet in the top left of the workbook. In the dialogue box which opens click on enable macros, ok. The spreadsheet should now be functional. "]
[]
["This data collection tool is made up of questions which can be used to assess how well your Trust is meeting recommendations made in \"Sepsis: Just Say Sepsis!\""]
[]
["Amending the tool to include more or less patients"]
["This tool has been set up to be completed on 10 patients."]
["If the audit is undertaken on less than 10 patients, please delete out the extra rows."]
["If the audit is undertaken on more than 10 patients, please add in additional rows by copying row 9 (before populated with patient data), and inserting the copied cells above row 10."]
["Following these steps will ensure the formulas work correctly."]
[]
["For information on the recommendation to which each question assesses please click on the         button. This will take you to the recommendations page. Please click on the Audit tool tab to return to the questionnaire."]
[]
["For date fields please insert using the dd/mm/yyyy format; please insert times using the 24 hour clock (hh:mm)"]
[]
["Where a question answer is highlighted in red, this indicates this is an area of care where the recommendation (or the question assessing a recommendation) is not being met. The more answers are highlighted in red, the more likely it is a recommendation is not being met. "]
[]
["Summary data is given at the bottom of the tool (audit tool tab)."]
[]
["As the questionnaire is completed a summary of responses is collated on the summary tab."]
["Each question that relates to a recommendation will become highlighted with the following "]
["Green - Recommendation sub criteria was met in 100% of the sample"]
["Amber - Recommendation sub criteria was met in between 50-90% of the sample"]
["Red - Recommendation sub criteria was met in less than 50% of the sample"]
["Blue - Recommendation sub criteria were not answered/not applicable for any of the sample"]
[]
["The sub criteria can be changed for the tool as a whole where necessary (not for individual questions). Where this is required please amend the % criteria values in the RAG system table on the summary sheet."]
[]
["As the questionnaire is completed the radar chart will be populated based on the answers given in the recommendation sub criteria. The percentage is worked out based on the number of cases completed; therefore if data is completed for only 1 patient and the subcriteria questions are all met then a Trust will be meeting 100% of recommendations. This must be considered when analysing the results. "]
[]
["Each number point on the chart relates to a recommendation; the higher the percentage, the more likely a recommenation is being met. The total percentage for each recommendation is also displayed below the sub criteria questions."]
[]
["In order for the formulas to work, an answer must be given for each recommendation subcategory; therefore please ensure NA's are input where prompted and appropriate"]
[]
["NCEPOD does not ask for any of this data back; it is for each Trust to make a judgement as to whether they are meeting recommendations."]

{"sheet":"Audit Tool","index":2,"n_rows":30,"n_cols":35,"rows_kept":30,"cut":false,"hidden":false,"merged":[[5,0,6,0],[2,1,2,3],[3,9,3,10]]}
["Just Say Sepsis!"]
[]
[null,"PATIENT DETAILS",null,null,"ADMISSION TO HOSPITAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EARLY MANAGEMENT OF SEPSIS",null,null,null,null,null,null,null,"DISCHARGE"]
["Recommendation"]
["Question number",1,2,3,4,5,"6a","6b",7,"8a ","8b ",9,10,"11a","11b ","12a","12b","13a ","13b",14,15,"16a ","16b ","16c",17,"17b ",18,19,"20a ","20b ","20c ",21,22,23,24]
[null,"Age at time of admission","Gender","Date and time of hospital admission","Mode of admission to hospital","Was sepsis hospital or community acquired?","Was a standardised sepsis proforma used for this patient?","If Yes to 6a, was this used to aid in the identification, treatment and ongoing management of sepsis","Was an early warning score used?","On arrival in the emergency department was a full set of vital signs undertaken?","If No to 8a, which of the following were undertaken:","Was consideration given to the likely source of infection?","Did the patient have an ongoing management plan?","Was control of the source of infection undertaken as soon as possible?","If Yes to 11a, was control undertaken within:","Date of sepsis identification","Time of sepsis identification","Once admitted, when was the patient first reviewed by a consultant?","Was the patient seen by a consultant within 14 hours after admission?","Is there evidence of a structured handover from the day team and out of hours team treating this patient?","Was a care bundle/ pathway used to govern the management of this patient following diagnosis?","Did the patient have an invasive procedure?","If Yes to 16a, was sepsis diagnosed after an invasive procedure?","If Yes to 16b, was a surgical site infection prevention bundle adopted?","Was this patient's treatment in line with your hospital anti-microbial policy?","If No to 17a, which of the following were documented in the patients medical records?","Was the case discussed with a senior microbiologist/ infectious disease specialist?","What was the discharge destination of this patient?","Was this patient admitted to critical care?","If Yes to 20a, was a follow up service provided by the hospital?","Was this patient provided with information on sepsis and long-term complications?","Was sepsis recorded on the discharge summary?","Was this case discussed at a mortality and morbidity meeting?","Was sepsis recorded on the death certificate?","Please provide any further comments relating to this case; with the benefit of hindsight is there anything that should have been done differently?"]
[null,null,null,"dd/mm/yyyy hh:mm",null,null,"Please see definitions",null,null,"Please see definitions","Answers may be multiple",null,null,null,null,"dd/mm/yyyy","hh:mm","dd/mm/yyyy hh:mm",null,null,null,null,null,null,null,"Answers may be multiple"]
["Patient 1",null,null,null,null,null,null,{"$f":"IF(G8=\"Yes\",\"\",IF(G8=\"No\",\"NA\",IF(G8=\"\",\"\")))","v":""},null,{"$f":"IF(OR(E8=\"\",F8=\"\"),\"\",IF(AND(E8=\"Admission via emergency department\",F8=\"Community acquired sepsis\"),\"\",\"NA\"))","v":""},{"$f":"IF(J8=\"Yes\",\"NA\",IF(J8=\"No\",\"\",IF(J8=\"NA\",\"NA\",IF(J8=\"\",\"\"))))","v":""},null,null,null,{"$f":"IF(N8=\"Yes\",\"\",IF(N8=\"No\",\"NA\",IF(N8=\"\",\"\")))","v":""},null,null,null,null,null,null,{"$f":"IF(F8=\"Hospital acquired sepsis\",\"\",IF(F8=\"Community acquired sepsis\",\"NA\",IF(F8=\"\",\"\")))","v":""},{"$f":"IF(V8=\"Yes\",\"\",IF(V8=\"No\",\"NA\",IF(V8=\"\",\"\",IF(V8=\"NA\",\"NA\"))))","v":""},{"$f":"IF(W8=\"Yes\",\"\",IF(W8=\"No\",\"NA\",IF(W8=\"\",\"\",IF(W8=\"NA\",\"NA\"))))","v":""},null,{"$f":"IF(Y8=\"Yes\",\"NA\",IF(Y8=\"No\",\"\",IF(Y8=\"\",\"\")))","v":""},null,null,{"$f":"IF(AB8=\"Discharged alive\",\"\",IF(AB8=\"Died\",\"NA\",IF(AB8=\"\",\"\")))","v":""},{"$f":"IF(AC8=\"Yes\",\"\",IF(AC8=\"No\",\"NA\",IF(AC8=\"\",\"\",IF(AC8=\"NA\",\"NA\"))))","v":""},{"$f":"IF(AC8=\"NA\",\"NA\",IF(AC8=\"\",\"\",IF(AC8=\"Yes\",\"\",IF(AC8=\"No\",\"\"))))","v":""},{"$f":"IF(AC8=\"NA\",\"NA\",IF(AC8=\"\",\"\",IF(AC8=\"Yes\",\"\",IF(AC8=\"No\",\"\"))))","v":""},{"$f":"IF(AB8=\"Died\",\"\",IF(AB8=\"Discharged alive\",\"NA\",IF(AB8=\"\",\"\")))","v":""},{"$f":"IF(AB8=\"Died\",\"\",IF(AB8=\"Discharged alive\",\"NA\",IF(AB8=\"\",\"\")))","v":""}]
["Patient 2",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 3",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 4",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 5",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 6",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 7",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 8",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 9",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
["Patient 10                                           Add new patient (above this row before populating with data)",null,null,null,null,null,null,"",null,"","",null,null,null,"",null,null,null,null,null,null,"","","",null,"",null,null,"","","","","",""]
[]
["Yes n",null,null,null,null,null,{"$f":"COUNTIF(G8:G17,\"Yes\")","v":0},{"$f":"COUNTIF(H8:H17,\"Yes\")","v":0},0,0,0,0,0,0,null,null,null,null,0,0,0,null,null,0,0,null,0,null,null,0,0,0,0,0]
["Yes %",null,null,null,null,null,{"$f":"IF(ISERROR(G19/G23),\"%\",G19/G23*100)","v":"%"},{"$f":"IF(ISERROR(H19/H23),\"%\",H19/H23*100)","v":"%"},"%","%","%","%","%","%",null,null,null,null,"%","%","%",null,null,"%","%",null,"%",null,null,"%","%","%","%","%"]
["No n",null,null,null,null,null,{"$f":"COUNTIF(G8:G17, \"no\")","v":0},{"$f":"COUNTIF(H8:H17, \"no\")","v":0},0,0,0,0,0,0,null,null,null,null,0,0,0,null,null,0,0,null,0,null,null,0,0,0,0,0]
["No %",null,null,null,null,null,{"$f":"IF(ISERROR(G21/G23),\"%\",G21/G23*100)","v":"%"},{"$f":"IF(ISERROR(H21/H23),\"%\",H21/H23*100)","v":"%"},"%","%","%","%","%","%",null,null,null,null,"%","%","%",null,null,"%","%",null,"%",null,null,"%","%","%","%","%"]
["Sub total",null,null,null,null,null,{"$f":"SUM(G19+G21)","v":0},{"$f":"SUM(H19+H21)","v":0},0,0,0,0,0,0,null,null,null,null,0,0,0,null,null,0,0,null,0,null,null,0,0,0,0,0]
["No data/not answered",null,null,null,null,null,{"$f":"G29","v":10},{"$f":"H29","v":10},10,10,10,10,10,10,null,null,null,null,10,10,10,null,null,10,10,null,10,null,null,10,10,10,10,10]
["Not applicable",null,null,null,null,null,{"$f":"COUNTIF(G8:G17,\"NA\")","v":0},{"$f":"COUNTIF(H8:H17,\"NA\")","v":0},0,0,0,0,0,0,null,null,null,null,0,0,0,null,null,0,0,null,0,null,null,0,0,0,0,0]
["Number of cases included in audit",null,null,null,null,null,{"$f":"G19+G21+G24+G25","v":10},{"$f":"H19+H21+H24+H25","v":10},10,10,10,10,10,10,null,null,null,null,10,10,10,null,null,10,10,null,10,null,null,10,10,10,10,10]
[false]
[]
["No data",null,null,null,null,null,{"$f":"COUNTIF(G8:G17, \"\")","v":10},{"$f":"COUNTIF(H8:H17, \"\")","v":10},10,10,10,10,10,10,null,null,null,null,10,10,10,null,null,10,10,null,10,null,null,10,10,10,10,10]
["Number of cases",null,null,null,null,null,{"$f":"IF(G24=G26,\"No data\", IF(G25=G26,\"NA\", IF(G24+G25=G26,\"NA\", G20)))","v":"No data"},{"$f":"IF(H24=H26,\"No data\", IF(H25=H26,\"NA\", IF(H24+H25=H26,\"NA\", H20)))","v":"No data"},"No data","No data","No data","No data","No data","No data",null,null,null,null,"No data","No data","No data",null,null,"No data","No data",null,"No data",null,null,"No data","No data","No data","No data","No data"]

{"sheet":"Answer sheet","index":3,"n_rows":16,"n_cols":13,"rows_kept":16,"cut":false,"hidden":true,"merged":[]}
["Answer1",null,"Answer2",null,"Answer3",null,"Answer4",null,"Answer5",null,"Answer6",null,"Answer7"]
["Male",null,"Transfer from another hospital",null,"Hospital acquired sepsis",null,"Yes",null,"Temperature",null,"1 hour",null,"Yes"]
["Female",null,"Admission via emergency department",null,"Community acquired sepsis",null,"No",null,"Pulse rate",null,"4 hours",null,"No"]
[null,null,null,null,null,null,null,null,"Respiratory rate",null,"12 hours",null,"NA"]
[null,null,null,null,null,null,null,null,"Blood pressure",null,"24 hours"]
[null,null,null,null,null,null,null,null,"Mental status (AVPU or GCS)"]
[null,null,null,null,null,null,null,null,"Capillary blood glucose"]
[]
[]
[]
["Answer8",null,null,null,null,"Answer9"]
["The indication of antimicrobial treatment including the suspected focus of infection",null,null,null,null,"Discharged alive"]
["Chosen antimicrobial regimen including dose",null,null,null,null,"Died"]
["Chosen antimicrobial regimen including route(s) of admission"]
["Chosen antimicrobial regimen including anticipated duration of antimicrobial treatment"]
["Chosen antimicrobial regimen including consideration of allergies/ drug interactions"]

{"sheet":"Summary","index":4,"n_rows":17,"n_cols":27,"rows_kept":17,"cut":false,"hidden":false,"merged":[[1,25,5,25],[1,26,5,26],[1,10,1,23],[8,10,8,23],[15,10,15,23]]}
[]
[null,null,null,null,null,null,null,null,null,null,"Recommendation - Sub criteria question number (reference only)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RAG system (NCEPOD recommends these are set at the following limits, however these can be adapted by your Trust where appropriate by amending the thresholds as required)","%"]
[null,null,null,null,null,null,null,null,null,null,4,5,8,9,11,12,13,14,15,16,17,18,19,20]
[null,null,null,null,null,null,null,null,null,null,"6a",7,"8a",9,"13b",15,"16c",17,18,"20c","20b",21,22,23]
[null,null,null,null,null,null,null,null,null,null,"6b",null,"8b",10,14]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"11a"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Green",100]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Amber",50]
[null,null,null,null,null,null,null,null,null,null,"Recommendation - Sub criteria questions (score)"]
[null,null,null,null,null,null,null,null,null,null,4,5,8,9,11,12,13,14,15,16,17,18,19,20]
[null,null,null,null,null,null,null,null,null,null,{"$f":"'Audit Tool'!G30","v":"No data"},{"$f":"'Audit Tool'!I30","v":"No data"},{"$f":"'Audit Tool'!J30","v":"No data"},{"$f":"'Audit Tool'!L30","v":"No data"},{"$f":"'Audit Tool'!S30","v":"No data"},{"$f":"'Audit Tool'!U30","v":"No data"},{"$f":"'Audit Tool'!X30","v":"No data"},{"$f":"'Audit Tool'!Y30","v":"No data"},{"$f":"'Audit Tool'!AA30","v":"No data"},{"$f":"'Audit Tool'!AE30","v":"No data"},{"$f":"'Audit Tool'!AD30","v":"No data"},{"$f":"'Audit Tool'!AF30","v":"No data"},{"$f":"'Audit Tool'!AG30","v":"No data"},{"$f":"'Audit Tool'!AH30","v":"No data"}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"'Audit Tool'!H30","v":"No data"},null,{"$f":"'Audit Tool'!K30","v":"No data"},{"$f":"'Audit Tool'!M30","v":"No data"},{"$f":"'Audit Tool'!T30","v":"No data"}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Audit Tool'!N30","v":"No data"}]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"Average % of recommendation"]
[null,null,null,null,null,null,null,null,null,null,{"$f":"IF(K11=\"No data\",\"No data\",IF(K11=\"NA\",\"NA\",IF(K11=\"%\",\"%\",SUM(K11:K12)/COUNT(K11:K12))))","v":"No data"},{"$f":"IF(L11=\"No data\",\"No data\",IF(L11=\"NA\",\"NA\",IF(L11=\"%\",\"%\",SUM(L11)/COUNT(L11))))","v":"No data"},{"$f":"IF(M11=\"No data\",\"No data\",IF(M11=\"NA\",\"NA\",IF(M11=\"%\",\"%\",SUM(M11:M12)/COUNT(M11:M12))))","v":"No data"},{"$f":"IF(N11=\"No data\",\"No data\",IF(N11=\"NA\",\"NA\",IF(N11=\"%\",\"%\",SUM(N11:N13)/COUNT(N11:N13))))","v":"No data"},{"$f":"IF(O11=\"No data\",\"No data\",IF(O11=\"NA\",\"NA\",IF(O11=\"%\",\"%\",SUM(O11)/COUNT(O11))))","v":"No data"},{"$f":"IF(P11=\"No data\",\"No data\",IF(P11=\"NA\",\"NA\",IF(P11=\"%\",\"%\",SUM(P11)/COUNT(P11:P12))))","v":"No data"},{"$f":"IF(Q11=\"No data\",\"No data\",IF(Q11=\"NA\",\"NA\",IF(Q11=\"%\",\"%\",SUM(Q11)/COUNT(Q11))))","v":"No data"},"No data","No data","No data","No data","No data","No data","No data"]

{"sheet":"Recommendations","index":5,"n_rows":15,"n_cols":2,"rows_kept":15,"cut":false,"hidden":false,"merged":[[0,0,0,1]]}
["RECOMMENDATIONS"]
[4,"Trusts/Health Boards should use a standardised sepsis proforma to aid the identification, coding, treatment and ongoing management of patients with sepsis (some examples are available at sepsistrust.org and survivingsepsis.org). To ensure continuity of care, this proforma should be compatible, where possible with any similar proforma or system used in primary care and should permit the data to be shared electronically. (Medical Directors, Primary Care Practitioners, Commissioners)"]
[5,"An early warning score, such as the National Early Warning Score (NEWS) should be used in both primary care and secondary care for patients where sepsis is suspected. This will aid the recognition of the severity of sepsis and can be used to prioritise urgency of care. (General Practitioners, Ambulance Trusts, Health Boards, NHSE, Clinical Directors, Royal Colleges)"]
[8,"On arrival in the emergency department a full set of vital signs, as stated in the Royal College of Emergency Medicine standards for sepsis and septic shock should be undertaken. (Emergency Medicine Physicians, Clinical Directors, Nursing Directors)"]
[9,"Where sepsis is suspected, early consideration should be given to the likely source of infection and the ongoing management plan recorded. Once identified, control of the source of infection should be undertaken as soon as possible."]
[11,"In line with previous NCEPOD and other national reports' recommendations on recognising and caring for the acutely deteriorating patients, hospitals should ensure that their staffing and resources enable:\na) All acutely ill patients to be reviewed by a consultant within the recommended national timeframes (max of 14 hours after admission)\nb)Formal arrangements for handover\n"]
[12," All patients diagnosed with sepsis should benefit from management on a care bundle as part of their care pathway.  The implementation of this bundle should be audited and reported on regularly. Trusts/Health Boards should aim to reach 100% compliance and this should be encouraged by local and national commissioning arrangements. (Medical Directors, Clinical Directors, Commissioners)"]
[13," For any invasive procedure a surgical site bundle should be employed as specified in NICE Clinical Guideline 74. (Medical Directors, Clinical Directors)"]
[14,"All healthcare providers should ensure that antimicrobial policies are in place including prescription, review and administration of antimicrobials as part of an antimicrobial stewardship process. These policies must be accessible, adhered to and frequently reviewed with training provided in their use. (Medical Directors, Commissioners, General Practitioners, Postgraduate Deaneries, Health Education England)"]
[15,"There should be senior microbiology input into the management of all patients identified with sepsis. This input should be available 24/7 and sought early in the care pathway. (Medical Directors, Sepsis Leads, Clinical Directors)"]
[16,"A booklet that provides patients and their relatives  with easy to understand information on the recognition of sepsis, its long-term complications, recovery and risk of recurrence should be available from all healthcare providers and be provided to patients with sepsis at discharge from hospital. Some examples can be found at the UK Sepsis Trust (sepsistrust.org) and ICU Steps (icusteps.org). (Medical Directors, Commissioners)"]
[17,"As for all acutely ill patients who are admitted to critical care, a follow-up service for patients with sepsis should be provided by the hospital which includes support and rehabilitation services, as recommended in NICE Clinical Guideline 83 and the Faculty of Intensive Care Medicine and Intensive Care Society Guidelines for the Provision of Intensive Care Services (GPICS). (Medical Directors, Clinical Directors, Sepsis Leads)"]
[18,"All patients discharged following a diagnosis of sepsis should have sepsis recorded on the discharge summary provided to the general practitioner so that it can be recorded in the patient’s GP record. (All Hospitals Doctors, General Practitioners)"]
[19,"For patients who die with sepsis, the care provided should always be discussed at a hospital multidisciplinary mortality meeting to encourage learning, and, where the source of sepsis has not been identified, an autopsy should be undertaken. (Medical Directors, Clinical Directors, Clinical Governance Leads, Sepsis Leads, All Clinical Staff)"]
[20,"When diagnosed, sepsis should always be included on the death certificate, in addition to the underlying source of infection. (All Doctors including Sepsis Leads)"]

{"sheet":"Definitions","index":6,"n_rows":3,"n_cols":2,"rows_kept":3,"cut":false,"hidden":false,"merged":[[0,0,0,1]]}
["DEFINITIONS"]
["Standardised sepsis proforma","The standardised sepsis proforma should be able to aid in the identification, treatment and ongoing management of patients with sepsis (some examples are available at sepsistrust.org and survivingsepsis.org)"]
["Full set of vital signs undertaken in emergency department as stated in the Royal College of Emergency Medicine standards","Temperature, pulse rate, respiratory rate, blood pressure, mental status (AVPU or GCS) and capillary blood glucose on arrival"]