Best Practice at Isle of Wight NHS Trust Ambulance Service
The Isle of Wight Trust pre-hospital sepsis protocol
The Isle of Wight Trust has developed a Pre-hospital sepsis protocol where intravenous antibiotics are administered by an Isle of Wight Ambulance Service Paramedic for adult patients with suspected sepsis who meet the criteria in a defined Patient Group Directive.
Pipercillin Tazobactum is the antibiotic selected but a high proportion of C. difficile cases in the Trust have been associated with its use. As a result, the Trust in-patient antibiotic guideline for sepsis of unknown source was changed to stop using piperacillin tazobactum as the first line antibiotic.
The change also brought our antibiotic guidelines more in line with those in neighbouring trusts. Use of co-amoxiclav instead of piperacillin tazobactum in the pre hospital setting would link in with the implementation of the in-patient antibiotic guideline.
Co-amoxiclav is not as broad spectrum as piperacillin tazobactam so the microbiological results profile of a cohort of pre-hospital sepsis protocol patients was investigated to determine if co-amoxiclav is a suitable alternative. Concordance between paramedic and ED diagnosis of sepsis appeared high.
The results suggest that switching from piperacillin tazobactam to co-amoxiclav as the intravenous antibiotic for the pre-hospital sepsis protocol is unlikely to have a significant impact in terms of adequacy of empirical microbiological spectrum.
The IOW Ambulance Protocol for the recognition and treatment of sepsis in pre-hospital environment is being updated in line with the mandatory implementation of NEWS2 scoring and threshold for treatment and using current definitions.
The results of this audit of the cohort of patients who were treated under the protocol support the clinical decision to switch to co-amoxiclav in this setting.