Dr. Vanessa Sweet is co-lead of the sepsis action improvement team in Nova Scotia Health’s central zone. By the end of October, nurses in emergency rooms across the province will be able to deliver treatment to anyone suspected of having sepsis.Darren Calabrese/The Globe and Mail
At a small hospital in rural Nova Scotia, registered nurse Terri-Anne McGregor checks the vitals of patients who trickle into the emergency room. She scans for signs of sepsis – fever, a racing heart and complaints that they feel so ill they think they’re going to die.
Sepsis is a life-threatening race against time. The body kicks into overdrive in response to an infection, which left untreated can destroy organs. Fatalities, pegged at around 18,000 a year in Canada, are considered preventable. The key is to detect it and act right away, which is what Ms. McGregor is now empowered to do.
Typically, doctors are responsible for prescribing antibiotics and other medications at emergency rooms.
In what’s being billed as a Canadian first for sepsis treatment, by the end of October, emergency-room nurses throughout Nova Scotia will be able to administer antibiotics and IV fluids to anyone suspected of having sepsis – a measure advocates say could be expanded to other provinces and territories.
“We just want to save lives,” said Ms. McGregor, who works at Twin Oaks Memorial Hospital, a 40-minute drive from Halifax.
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The measures were introduced at six health facilities in January, 2024, and early indicators show the changes have been effective. Data released earlier this year showed a nearly 30-per-cent increase in patients who met sepsis criteria being given antibiotics in a critical three-hour window. This fall, the approach is being scaled up provincewide.
The changes in Nova Scotia follow several cases that involved serious, and sometimes fatal, cases of sepsis and families that have publicly called for reform.
One of those patients was Lindsey Hubley, who gave birth at a Halifax hospital in 2017 and developed necrotizing fasciitis, a bacterial infection also known as flesh-eating disease. It started on her perineum and spread to her limbs, stomach, hips and buttocks.
The infection became so severe, her body went into septic shock less than two days after she gave birth – a risk she knew nothing about at the time but resulted in the loss of her hands and lower legs.
(She later sued the hospital where she gave birth and has signed a non-disclosure agreement that precludes her from discussing her care leading up to the sepsis.)
Lindsey Hubley lost her hands and lower legs after developing sepsis following an infection post-birth.Darren Calabrese/The Globe and Mail
Ms. Hubley believes there needs to be greater awareness about sepsis. She said giving nurses in Nova Scotia the power to administer antibiotics is an important new step to prevent severe outcomes.
“Why isn’t the whole country on board?” she asked. “If it can save lives, and quality of life, why not?”
Alison Fox-Robichaud, scientific director at Sepsis Canada, a national research network, called the Nova Scotia Health Authority’s approach “innovative.”
Early recognition helps keep patients out of the ICU, she said, adding it also prevents organ failure and the need for long-term medical support. It is key to detect signs “before it gets so life-threatening that we can’t turn things around.”
Dr. Fox-Robichaud said Canada needs a cross-country action plan on sepsis akin to what is in place in some other countries such as Britain, which has guidelines for early diagnosis and prompt treatment.
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Vanessa Sweet, an anesthesiologist and physician co-lead for the sepsis action improvement team in Nova Scotia Health’s central zone, said the changes in emergency rooms to the protocols around the detection and treatment of sepsis have already led to improvements in patient care.
“If we’re getting patients their antibiotics within that three-hour window, all of their other clinical outcomes are better as well,” Dr. Sweet said.
In creating its action plan, the Nova Scotia Health Authority drew lessons from NHS Scotland, the publicly funded health care system in that country, and from the B.C. Sepsis Network, an initiative by clinicians in that province.
Over the past 13 years, the B.C. network has worked to improve detection and treatment of sepsis, said David Sweet, a physician at Vancouver General Hospital and clinical lead of the B.C. Patient Safety and Quality Council (no relation to Vanessa Sweet). A 2021 study estimated the network averted 981 sepsis cases and 172 deaths between 2014 and 2018.
The B.C. initiative focuses on education and a standardized approach for patients who meet specific criteria, including that they should ideally be seen by a physician within 15 minutes.
While there is no specific directive for nurses to administer the first dose of antibiotics like in Nova Scotia, Dr. Sweet said B.C. doctors can quickly engage with a nurse and assess patients, and the doctor can prescribe antibiotics right away if deemed appropriate. Patients also have blood work done and receive IV fluids.
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Ontario resident Gurinder Sidhu is pushing for reforms to sepsis protocols to ensure early detection and treatment. He believes his wife, Ravinder, would be alive to watch their three children grow up had she not waited more than 30 hours to receive antibiotics.
In June, she delivered their baby shortly before their 10th wedding anniversary. They had made plans to mark the milestone after the birth.
But instead of getting to celebrate, Mr. Sidhu planned his wife’s funeral. She died four days later. She had developed postpartum sepsis that went on to cause organ failure.
Mr. Sidhu is haunted by having watched his wife’s health decline in the hospital while he advocated for medical interventions.
“Her screams are going to be the trauma for my life,” he said.
Mr. Sidhu also supports a directive like the one in place in Nova Scotia to empower nurses to administer the first dose of antibiotics.
Ontario Health Minister Sylvia Jones recently told The Globe and Mail that sepsis protocols are a clinical decision.
Ms. Hubley said there needs to be greater awareness about sepsis.Darren Calabrese/The Globe and Mail
While questions remain about whether other jurisdictions will update sepsis protocols, Ms. Hubley has a plea similar to Mr. Sidhu’s – that time is of the essence.
Years after surviving sepsis, she knows her life expectancy is much reduced. And she wonders how many years she has left to spend with her son, who is now 8.
“I’m so strong until I talk about him,” Ms. Hubley said, her voice breaking.
“That’s my biggest sadness – years have been taken off my life and that’s not fair. So that’s why early detection is important.”
With a report from Laura Stone in Toronto
