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 The UK Multi-Professional Critical Care Outreach, Medical Emergency, 
                         Acute and Rapid Response Teams Forum


Reducing harm and improving patient safety 

Sepsis and Acute Kidney Injury (AKI)

1000 Lives Improvement has a key role in supporting several networks and targeted work programmes across NHS Wales aimed at reducing harm.

Rapid Response for Acute Illness Learning Set (RRAILS)

We lead a Rapid Response for Acute Illness Learning Set (RRAILS) programme which brings together all health boards and trusts in Wales to reduce harm and death caused by acute deterioration, and to achieve consensus on an integrated approach to the treatment of sepsis and Acute Kidney Injury (AKI).

Sepsis prevention and treatment

Sepsis is thought to be the cause of around 2200 deaths per year in Wales. For over 8 years, the RRAILS programme has been supporting the prevention of harm and death due to sepsis in NHS Wales. The Global Sepsis Alliance recognised the work of NHS Wales for its sepsis awareness and education initiatives at the 2016 Global Sepsis Awards.

Tools supporting early sepsis intervention across NHS Wales

NEWS (National Early Warning Score)

Wales became the first country to implement NEWS as the standard. The life-saving intervention is now an integral part of care in hospitals nationwide.

Single-use sepsis box

This tool under trail at Cwm Taf University Health Board (developed with the health board and 1000 Lives Improvement, and produced by Rocialle as part of the Bevan Commission's Healthcare Technology Exemplars) has been designed to facilitate the early and effective treatment of sepsis at the earliest time. 

The single-use box contains all the items required to ensure early intervention and prompt delivery of the sepsis six care bundle. Items are stored in the correct order for administration, in their own compartment and in their own sterile packaging to promote infection control.


A collaboration between 1000 Lives Improvement, NHS Wales health boards and trusts, the Institute for Nephrology at Cardiff University and funded by a Health Foundation grant. 

 AKI-PRO uses tools developed by clinicians from Wales and London, together with designers from the Helen Hamlyn Centre for Design to:

  • Support doctors in recognising AKI through the communication of abnormal renal blood tests from the lab to clinicians.
  • Support nurses looking after patients with AKI through the Wee Wheel tool.
  • Enable patients to take an active part in their care through the Kidney-safe wristband.

Tools supporting NHS Wales and patients to recognise AKI

Wee Wheel

A calculator wheel that supports nurses in looking after patients with AKI by gauging whether patients’ volume of urine output is enough.

Kidney Safe Wristband

A wrist band worn by patients to remind them to check whether their urine is concentrated and to alert clinical teams to their condition.

For more information on our work, see the 1000 Lives Improvement brochure 

    Chris Hancock, 1000 Lives Improvement RRAILS programme lead, chris.hancock@wales.nhs.uk   @1000LivesWales / @chris23ha


Launch of ABC Sepsis
Reducing Death from Sepsis in 2015

This collaborative is important, not just to this Health Board, but to me personally as I have had too many final conversations with patients and looked into the eyes of too many children who I knew would not survive because of sepsis”. With these emotive words Paul Buss, Paediatrician and Medical Director of Aneurin Bevan University Health Board (ABUHB) launched the organisation’s sepsis collaborative programme for 2015.

This event marked the starting point for the Health Board of what will be a year of intense activity with the single aim of reducing the number of deaths due to sepsis. The plan is to start making improvements with small clinical teams in two emergency departments and two ward areas and then to roll out learning and success from these to the rest of the organisation over a series of 90 day periods. They will be closely supported in doing this by a team from 1000 Lives Improvement including David Williams and myself.

Although ABUHB have achieved a lot as part of the All Wales Rapid Response to Acute Illness Learning Set (RRAILS) in terms of standardising processes and improving recognition of acute deterioration using NEWS, they, in common with all other Welsh Hospitals, have so far failed to demonstrate a reduction in mortality due to sepsis specifically.
In order to learn how to we might achieve this goal four colleagues and I were fortunate enough to visit Dartmouth-Hitchcock Healthcare as part of a study tour. Dartmouth-Hitchcock is a healthcare system in New Hampshire which serves a population of almost two million. In an astonishing period of just seven months in 2013, building upon the learning from the High Value Healthcare Collaborative (HVHC) of which they are a member they demonstrated, amongst other successes, a reduction in sepsis related deaths in the Emergency Department from a rate of approximately 50% to zero.

In my opinion the single biggest factor influencing the achievement of this was the decision made by CEO Jim Weinstein that ‘this unacceptably high death rate from sepsis in this organisation will stop”. The positive actions and results that followed at considerable pace all flowed from this initial well publicised and non-negotiable decision at the head of the organisation.

This is why I was so impressed to hear Paul demonstrate his personal commitment at this organisational meeting but to also see the attendance of Denise Llewellyn, Director of Nursing and many senior ABUHB figures. It was also noticeable that even at a time of unprecedented Winter pressures the attendance from the Emergency departments was considerable demonstrating the commitment to reduce sepsis mortality from ‘Ward to Board’.

The overriding message expressed was not so much permission but an expectation that all staff should act to recognise, escalate and rapidly treat sepsis. This expectation is neatly encapsulated in the strap line that the collaborative is adopting from the UK Sepsis Trust “Sepsis – spot it, treat it, together we can beat it”.



19th October 2016

Rapid Response to Acute Illness Learning Set (RRAILS) Study Day

Thursday 22nd January 2015

Premier Suite, SWALEC Stadium, Cardiff

Implementing the National Early Warning Score (NEWS) in a Private Care Setting, Karen Beech
Using NEWS and Sepsis Criteria to Assess the Acutely Unwell Patient in Primary Care, Dr Sally Lewis

Pre Hospital Recognition of and Response to Sepsis by Welsh Ambulance Service, Mike Jenkins, Jacqui Jones, Steve Johnson, Welsh Ambulance Service Trust (WAST) 

Identification and treatment of Sepsis in the Emergency Department, Jennie Palmer
Achieving Zero: learning from the United States on reducing sepsis mortality, Chris Hancock

Size of Sepsis Study: Spread to all Wales for 2015?, Robert Lundin, Ben Sharif


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