Recognising and Managing Sepsis

Joe-Anne Bendall¹, Mary Fullick²

¹Clinical Excellence Commission, 2-24 Rawson Place, Haymarket, NSW 2000, Joe-Anne.Bendall@health.nsw.gov.au

²Clinical Excellence Commission, 2-24 Rawson Place, Haymarket, NSW 2000, Mary.Fullick@health.nsw.gov.au

Sepsis and septic shock are life threatening conditions that may be difficult to diagnose as severity varies. This poses challenges for clinicians because the early recognition and management of sepsis is crucial in terms of morbidity and mortality. It is estimated that mortality ranges from 10-40% when shock is present [1].

Sepsis accounts for up to 30% of Rapid Response calls and is a common cause of in-hospital death. The Clinical Excellence Commission (CEC) identified in 2009 that sepsis was a major concern for patients when Root Cause Analysis Reports were themed. This report compelled a patient safety initiative to reduce sepsis and septic shock [2]. The CEC introduced the SEPSIS KILLS program to all New South Wales (NSW) public health facilities from 2011 to reduce preventable harm to patients with sepsis. The program builds on the foundations of the statewide safety net system for deteriorating patients ‘Between the Flags’ which has enabled widespread system change and reduction in patient harm[3].

The NSW SEPSIS KILLS supports clinicians to recognise and respond to all patients with sepsis. The three key actions for NSW clinicians are:

RECOGNISE risk factors, signs and symptoms of sepsis

RESUSCITATE with rapid intravenous fluids and antibiotics and

REFER early to senior clinicians and teams

More than 80% of patients with suspected sepsis receive their first antibiotic within 2 hours. Overall mortality has reduced from 19.4% (2009-11 pre-intervention) to 14.1% (2013) and there has been a decrease in hospital length of stay and intensive care⁵. Ongoing analysis has shown the overall mortality from in-hospital sepsis has further decreased to 13.88 % in 2016. [3]

References

1. Evaluation and management of suspected sepsis and septic shock in adults. UpToDate July 2018
2. Clinical Excellence Commission, (2009) Clinical Focus Report from review of  root cause analysis and/or incident information management system (IIMS) data recognition and management of sepsis; Sydney.
3. Burrell AR, McLaws ML, Fullick M, Sullivan RB, Sindhusake D. SEPSIS KILLS: early intervention saves lives. The Medical Journal of Australia 2016, 204(2):73.