Frequently asked questions
On this page you will find answers to frequently asked questions regarding the use of the sepsis pathways in your service.
Q: Why have the sepsis pathways been revised?
A: The adult, maternal, paediatric and neonatal sepsis pathways have been revised to align with the national Sepsis Clinical Care Standard and current evidence-based guidelines. Improvements were also recommended by NSW clinicians and expert working groups and the revision process was overseen by a Sepsis Pathway Expert Advisory Group. A statewide consultation process with the LHD/SHNs was conducted prior to their release.
Q: When should the new pathways be implemented?
A: The timeline and plan for transition to the new pathways will be determined by the LHD/SHN/facility and supported by a sepsis pathway promotion campaign. A variety of resources are available to support local implementation here .
Q: Why should the sepsis pathways be used?
A: Sepsis should be considered in any clinical setting for patients with an acute illness or acute clinical deterioration. The use of sepsis pathways as clinical decision support tools are supported by the Sepsis Clinical Care Standard. Any clinician can activate the relevant sepsis pathway at any time. The pathway will support the clinician to identify sepsis risk factors, signs and symptoms, escalate to a senior clinician and commence treatment rapidly.
Q: Are the sepsis pathways available in the electronic medical record (eMR)?
A: The CEC are collaborating with eHealth to make the pathways accessible in the eMR to support use at the point of care. A digital sepsis solution will be developed in the Single Digital Patient Record.
Q: How do the sepsis pathways align with the ECAT protocols used in emergency departments?
A: Emergency care assessment and treatment (ECAT) is a statewide program that aims to standardise nurse-initiated emergency care. The Adult ECAT sepsis protocol and Paediatric ECAT sepsis protocol align with the CEC sepsis pathways. They authorise nurses who have completed the required education and training to initiate the investigations and medications as outlined on the relevant protocol.
Q: Can the sepsis pathways be used if the patient is neutropenic?
A: Local febrile neutropenia guidelines should be used as the guidance will be more specific and timelines may be different.
Q: Are some groups of people at a higher risk of developing sepsis?
A: There is a significantly higher incidence of sepsis in people with immune system issues (age or illness/treatment related) such as immunocompromised patients, babies and children under 1 year and elderly patients. Other vulnerable patient groups include those in remote areas, low socioeconomic groups, who are homeless, from culturally and linguistic diverse backgrounds, and Aboriginal and Torres Strait Islander people. Clinicians should have a higher index of suspicion for these patients and use the appropriate sepsis pathway to support assessment.
Q: Why are re-presentations to hospital an important risk factor for sepsis?
A: People who re-present with the same or worsening condition or patients who do not respond to treatment in hospital, may be at risk of clinician cognitive bias and diagnostic anchoring. Considering differential diagnoses, asking ‘Could it be sepsis?’ and escalating to a senior clinician may effectively prevent unintended harm.
Q: Who is the ‘senior clinician’ and why is early involvement essential?
A: Sepsis is a medical emergency and needs a team response. Determination of the ‘senior clinician’, is facility dependent. It is important to know who the nominated senior clinician(s) are for the area that you work in and for that to be communicated to the clinical team.
Any patient with suspected sepsis needs to be promptly assessed by a senior clinician (directly person to person) with expertise in recognising and managing sepsis or patient deterioration. Escalating to a senior clinician may effectively prevent unintended harm from a missed or delayed diagnosis and/or treatment.
Q: Why is lactate measurement important in sepsis?
A: Lactate is a non-specific marker of illness severity in acutely ill patients. A lactate level greater than 2mmol/L is significant in sepsis. A lactate of ≥ 4mmol/L is a Red Zone criterion and requires a Rapid Response call (except neonates). Lactate can be quickly and easily measured using point of care testing or a blood gas. Find more information in the Lactate in the Deteriorating Patient information sheet and video.
Q: Why should blood cultures and infective site samples be taken prior to administration of antimicrobials?
A: Blood cultures enable the detection of bacteria and/or fungus in the blood and guide the appropriate selection of antimicrobials. Blood cultures should be collected before commencing antimicrobial therapy to avoid a significant loss of pathogen detection. If establishing intravascular access or obtaining blood cultures is very difficult and the patient is unstable, the priority is to start antimicrobial treatment. Do not wait for results of tests to start the antimicrobials.
Q: How does antimicrobial administration and stewardship align?
A: Antimicrobial administration guidance on the pathways aligns with the Sepsis Clinical Care Standard and the Antimicrobial Stewardship Clinical Care Standard. Both Standards support rapid administration of antimicrobials for any patient with suspected sepsis.
After the initial doses have been administered it is important to monitor the clinical response closely, adjusting antimicrobials according to further history and results of investigations over the next 24 to 48 hours. Active follow up of culture results and review of antimicrobial therapy within 48 hours from initial dose is essential to optimise treatment for pathogen-directed antimicrobial therapy or change the management plan if needed.
Q: Where is the sepsis management plan?
A: The sepsis management plan (previously Page 4) for use in the first 48-72 hours after initial sepsis treatment has been removed. The ongoing sepsis management plan should now be documented in the respective patients’ health care record, discussed with the Attending Medical Officer, and be communicated with the clinical team. The management plan should include close observation and vital sign monitoring requirements (there is a high risk of further deterioration), follow up of pathology results to confirm the diagnosis and treatment, and regular review of the patient with a senior clinician.
Formal feedback from clinicians indicated the sepsis management plan was infrequently used in the clinical setting and was a duplication of documentation.