Sepsis is a life-threatening and time-critical medical emergency with long-ranging consequences for patients that survive. This is the message set out in the Sepsis Clinical Care Standard (the Standard), recently released by the Australian Commission on Safety and Quality in Health Care.
Nurses play a pivotal role in recognition of sepsis, time-critical treatment and ongoing coordination of care – all key elements of the new national Standard.
The World Health Organization recognised sepsis as a global health priority in 2017, since it is the leading preventable cause of death worldwide. World Sepsis Day is held on 13 September each year and reminds people globally of the urgent need to improve education and ‘Stop Sepsis, Save Lives’.
The burden of disease from sepsis in Australia is high, with over 55,000 cases and more than 8700 deaths annually.1 It was clear that the Australian health system could provide more support for recognising and responding to patients with sepsis – and this was recognised in Australian Government funding to the National Sepsis Program in to support better patient outcomes.
The Sepsis Clinical Care Standard2 will help to reduce variation in care for patients with sepsis in Australia and support health service organisations to prioritise improvements to sepsis care throughout a patient’s journey – including increasing the urgency of early intervention. It provides guidance from symptom onset, to discharge from hospital and survivorship care.
Developed to address the need for national clinical guidance to support improvements in the delivery of sepsis care in healthcare services, the Standard is relevant to all patients – neonatal, paediatric and adult in the primary and community care, acute and non-acute settings.
The challenge of recognising sepsis
Despite sepsis being described as the most common preventable cause of death and disability, it can be difficult to diagnose sepsis in patients who deteriorate in hospital or present to emergency departments.
While many states and territories already include specific actions to recognise and respond to patients with sepsis as part of their rapid response processes, some members of the community remain at greater risk.
The very young, the elderly and Aboriginal and Torres Strait Islander populations are disproportionately represented. Many patients who survive sepsis have serious complications, ongoing health concerns and increased risk of death post-discharge.
It is important that heath service organisations have processes in place for nurses and other clinicians to recognise not only the signs of deterioration but also the possible underlying causes, and to act early to improve outcomes. This major change in the National Consensus Statement: Essential elements for recognising and responding to acute physiological deterioration3 occurred in the third edition, released by the Commission last year.
The National Consensus Statement emphasises the importance of determining the reason for any patient deterioration, including forming, testing, communicating, managing and documenting potential diagnoses like sepsis.
Response systems can be tailored to individual patient circumstances so that the early activation of care aligns with the patient’s diagnosis. Sepsis pathways have gained traction4 to help expedite treatment in rapid response systems, as well as emergency departments, and are a key part of the clinical care standard.
As nurses, it is important to understand what we can do within our scope of practice to recognise sepsis and provide interventions as soon as possible. This can include:
- Using the rapid response system to ensure care is escalated and patients are managed in the most appropriate care setting
- Taking blood cultures and initiating other tests like lactate measurement, that are part of sepsis pathways
- Initiating antimicrobial therapy and intravenous fluids in line with hospital policies
- Ensuring families and carers know and can escalate care when they are concerned.
Coordinating ongoing sepsis care
Nurses also play a key role in identifying and managing the ongoing priorities for care of sepsis patients after urgent management has been completed. This includes supporting survivors to achieve the best possible outcomes so that they are less likely to be re-hospitalised later, as well as supporting families and carers when people die.
The Standard emphasises the need for care coordination, in recognition of the complex care needs of many sepsis survivors. This is because up to half of people who suffer sepsis and survive have ongoing medical problems which affect their physical, psychological and cognitive wellbeing.
Seven quality statements and corresponding quality indicators in the Standard focus on the time critical aspects of early intervention through to follow-up after episodes of care in hospital. The aim is to reduce the impact of sepsis on patients, support clinical decision making and ensure the system is geared to improve outcomes in Australia.
Nurses have a crucial role in supporting timely recognition of sepsis and escalation of care – and embedding this in clinical practice will help to reduce death and disability from this devastating condition.
Learn more at: safetyandquality.gov.au/sepsis-ccs
Marghie Murgo is senior nursing advisor at the Australian Commission on Safety and Quality in Health Care.
Wayne Varndell is a clinical nurse consultant at Prince of Wales Hospital, associate lecturer, School of Nursing and Midwifery at UTS, and president-elect, College of Emergency Nursing Australasia.
1. Li L, Sunderland N, Rathnayake K, et al. Sepsis epidemiology in Australian Public Hospitals, a nationwide longitudinal study (2013-2018). Infection, Disease & Health 2021;26:S9. doi: 10.1016/j.idh.2021.09.032
2. Australian Commission on Safety and Quality in Health Care. Sepsis Clinical Care Standard. Sydney: ACSQHC, 2022.
3. Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for recognising and responding to acute physiological deterioration 3rd ed. Sydney: ACSQHC, 2021.
4. Li L, Rathnayake K, Green M, et al. Comparison of the quick Sepsis-related Organ Failure Assessment and adult sepsis pathway in predicting adverse outcomes among adult patients in general wards: a retrospective observational cohort study. Intern Med J 2021;51(2):254-63. doi: 10.1111/imj.14746 [published Online First: 2020/01/08]