Sepsis pathway

[Luis Mata Mendez]

Hi everyone,

I’m currently developing an “Early Recognition and Escalation of Suspected Sepsis in Older Adults” procedure specifically for Residential Aged Care and Transition Care settings and I would really value feedback, experiences and suggestions from others working in the sector.

One of the key things I found during this work is that most available sepsis pathways in Australia are designed for acute care and emergency department settings. While these pathways are excellent for hospitals, I found they do not always translate well into the RACF environment where:

– presentations are often subtle and atypical
– residents may not meet traditional “red flag” criteria early
– delirium, behavioural change or functional decline may be the first sign of infection or sepsis
– access to pathology, lactate testing and rapid medical review is limited
– goals of care, ACPs and AHDs significantly influence escalation decisions.

The RACGP Silver Book highlights that older adults often present atypically and that fever may be absent in 30–50% of frail older adults. It also notes that sudden confusion, delirium, falls or functional decline are very common presentations of infection and sepsis in aged care.

This led me to move away from trying to adapt an acute-care sepsis bundle directly into aged care and instead focus on:

– early recognition of “not their usual self”
– escalation based on subtle deterioration
– integration with existing clinical deterioration and delirium processes
– nurse assessment and GP/NP escalation pathways
– resident-centred decision making
– practical workflows that actually fit RACF operations.

Interestingly, while I found some overseas nursing home and long-term care sepsis resources, particularly from the US, I struggled to find an established Australian RACF-specific sepsis recognition and escalation pathway. That makes me think there may actually be a gap in this area nationally.

I’d really love to hear from others:

– Has your organisation developed a RACF-specific sepsis pathway or escalation process?
– How are you approaching early recognition in residents with dementia, delirium or atypical presentations?

I’m very open to feedback and keen to learn from others working in this space.

Kind regards,

Luis Mata-Mendez
Clinical Lead Infection Prevention and Control
Health Care Quality
Amana Living Corporate Office Level 1, 541 Hay Street Subiaco 6008 WA
PO Box 933 Subiaco WA 6904
Mobile: 0449 944 545 – Email: lmendez@amanaliving.com.au

[Carrie Spinks]

This is a fantasitc initiative Luis

This article may assist with your journey: Sepsis in Older Adults in Long-Term Care Facilities: Challenges
in Diagnosis and Management: https://files.commons.gc.cuny.edu/wp-content/blogs.dir/5363/files/2020/11/Sepsis-in-Older-Adults-in-Long-Term-Care-Facilities-Challengesin-Diagnosis-and-Management.pdf

Regards Carrie

[Carrie Spinks]

Hi Luis,

Also wanted to present this resource:

Could it be Sepsis – Sepsis Australia – https://www.safetyandquality.gov.au/resources/could-it-be-sepsis-easy-read

Regards Carrie

[Author]

Posts