As part of our acknowledgement of World Sepsis Day, we’ve dedicated the entire month of September to sepsis.
Since the development of the adult and paediatric sepsis clinical pathways, we’ve received wide-ranging feedback from clinicians about how their perceptions of sepsis or the way it is managed have changed.
And now, we’re bringing you some of these stories. Today we hear from Dr Marlow Coates, Northern Director of Medical Services, Torres and Cape Hospital and Health Service. Even though the region had developed its own sepsis guide, Marlow came on board with the Statewide project as Chair of the Rural and Remote Sepsis Project to help standardise the rural and remote sepsis pathway.
‘Sepsis and septic shock are one of the more common reasons for hospitalisation in tropical north Queensland.’ And it seems Marlow’s not wrong – at the time we interviewed him in late August, Thursday Island had seen five septic patients that week.
‘We are more attuned to it, but what the pathway does is encourage us to prove it is or isn’t sepsis, to treat early and broadly, and increase the level of concern within the treating team.’
Marlow went on to share two examples of the pathway in use in the Torres and Cape.
A community member became febrile and was taken to the emergency department where they were immediately diagnosed with sepsis and then septic shock. ‘They were given full wet season, probable skin source sepsis antibiotics (ABs) within 30 minutes,’ Marlow says. ‘Inotropes were also up and running really quickly, following the pathway to the letter and in a very fast timeframe.’
‘What was positive about this case was that not only was the septic shock able to be identified very fast, there was no guessing about ABs or looking up online guides. They were given very fast and inotropes were quickly and appropriately initiated. What would sometimes take a couple of hours is now done in sub-60 minutes because of the pathway.’
Marlow says the speed at which sepsis can be identified and managed has sped up significantly at their sites. ‘[This is] partly due to the easy nature of the pathway but also because it allows nurses to administer antibiotics in a fast and prioritised fashion and the nurses feel supported by the guideline.’
‘This is a game changer in my view.’
An elderly patient presented to a remote clinic with fever, tachycardia, tachypnoea and hypotension, with a likely septic shock from skin or respiratory source. Care was appropriately escalated, with priority given to IV access, IV fluids, antibiotics, and then inotropes. Retrieval was tasked. Marlow said she responded very well to therapy and within 12 hours they had weaned the inotropes. A few days later, she was recovering on the ward, waiting to return home.
Marlow attributes the positive outcomes of this case again to the speed at which the pathway allows for treatment to commence. ‘The quick identification from the nurse that this is an emergency, prompt escalation, fast administration of antibiotics and fluids and the inotropes for blood pressure support all meant this lady had optimal therapy without delay. If these steps had taken hours instead of minutes, she would likely have required transfer to tertiary care.’
‘Instead she was treated entirely on country.’
A total of 93 rural and remote sites opted to rollout the paediatric and adult sepsis clinical pathways in Queensland. Marlow’s advice to those who aren’t using the pathways or haven’t heard of them is straightforward.
‘The pathways are a very worthy body of work. Clinicians have overwhelmingly found it makes identifying and managing sepsis less complicated. It reduces the decision-making burden during times of pressure and guides the prioritised actions to improve outcomes.’