What is a Sepsis Pathway?
The pathway is a clinical decision support tool providing a standardised approach to early identification and management of patients with sepsis.
It includes four main steps:
- Recognition – Ask: Could it be sepsis? Check for signs and symptoms of sepsis and identify high-risk people
- Response – Escalation of ‘sepsis review’ to a senior clinician or Medical Response Team (MET)
- Resuscitation – Oxygen, Blood Cultures, IV antibiotics and IV fluids within 60 minutes
- Refer and reassess – Monitor treatment response and refer/transfer if further care is needed
How were the pathways developed?
Adult, maternal and paediatric sepsis pathway working groups comprised of medical and nursing representatives from across the state oversaw development of the pathways. The working groups aligned the pathways with the national Sepsis Clinical Care Standard and current evidence-based guidelines. A broad consultation process was conducted statewide across Health Service Providers (HSPs).
Why do we need the pathways?
Pathways support a statewide standardised approach to identify the signs and symptoms of sepsis, when to escalate for senior clinician review and when to commence urgent treatment as required. They support best practice and follow local escalation processes.
Who can activate a sepsis pathway?
Each hospital or service area will decide how best to use the pathway, but it can be activated by any WA Health clinician, including allied health staff, junior nurses and clinicians of all levels up to medical consultants.
When should I use a sepsis pathway for my patient?
- When anyone, including your colleagues, family or carers, asks the question: ‘Could it be sepsis?’
- Any patient with possible infection who looks very unwell, has vital sign observations or trends on the Observation and Response Chart indicating active deterioration, and/or has an elevated lactate level
- Hospital presentations, including to an emergency department, with known sepsis
Following the pathway is recommended, however it does not replace senior clinician judgement.
Which pathway should I use?
For children younger than 16 years, the paediatric pathway should be used.
For patients aged 16-18 years use either the paediatric or adult pathway.
The maternal sepsis pathway is for patients who are pregnant or within 6 weeks following birthing or following pregnancy loss.
Febrile neutropenia guidelines should be used if you suspect neutropenic sepsis as the guidance is more specific and timelines may be different.
Who is the ‘senior clinician’ referred to in the pathway?
In the acute setting this will usually be the Senior Medical Officer attending the medical review or MET/MER call. In some services, it may be the on-call doctor, the most senior nurse or midwife or the emergency telehealth service (ETS) personnel.
It is important to know who the designated senior clinician is in your work area and the appropriate process for escalating a review.
When would I stop using the pathway?
If the Senior Medical Officer or MET/MER team who reviewed the patient has ruled out sepsis as a possible or probable cause of deterioration, you should stop using the pathway. The reason why sepsis has been ruled out, or judged to be unlikely, should be documented in the patient notes.
Remember, you can restart this pathway anytime or request another sepsis review, especially if the patient re-presents or continues to deteriorate.
Does the pathway include recommended antibiotics?
No, but the pathway includes a link to the Therapeutic Guidelines – Antibiotics which details recommended antibiotics for initial therapy of up to 48 hours. Your hospital may also have local antimicrobial guidelines available.
For complex patients such as those with potential multidrug resistant infection, consultation with an infectious diseases physician or clinical microbiologist may be warranted.
What areas and services should use the pathway?
Pathways should be available anywhere patients present or are cared for, including emergency departments, wards and outpatient areas. The pathways are designed for hospital use in combination with the Observation and Response Chart and hospital escalation processes.
Is there education available on sepsis or the pathways?
Your health service provider (HSP) or service may already have local training available. You can search on MyLearning, your local e-learning platform or speak with your local educator for more information.
Where can I find information for consumers?
There is a QR Code/link on the bottom of the pathway that can be used to access consumer resources. Alternatively, they can be accessed under standardised consumer resources. You can also visit Sepsis Australia (external site) for additional resources.