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澳大利亚发布脓毒症临床诊治标准

2022年07月04日 ⁄ 指南导读, 进展交流 ⁄ 暂无评论

On June 30, 2022 the Australian Commission on Safety and Quality in Health Care (the Commission) has released the national Sepsis Clinical Care Standard, in partnership with The George Institute for Global Health.

It is an achievement that Australia has reached broad consensus across the health sector, to become one of the first countries to release a nationally agreed quality framework for the recognition and management of sepsis.

The standard outlines optimal care for patients in hospital with suspected sepsis – from the onset of signs and symptoms, through to discharge from hospital and follow-up care.

Indicators for the Sepsis Clinical Care Standard

Indicators have been developed to support monitoring of the care recommended in the Sepsis Clinical Care Standard. Clinicians and healthcare services can use the indicators to support local quality improvement activities.

Indicator specifications

Measurement is a key component of quality improvement processes. The Commission has developed a set of indicators to support clinicians and healthcare services to monitor how well they are implementing the care recommended in this clinical care standard. The indicators are intended to support local quality improvement activities. No benchmarks are set for these indicators by the Commission.

The definitions required to collect and calculate indicator data are specified in the Metadata Online Registry (METEOR): meteor.aihw.gov.au/content/index.phtml/itemId/755589External link

METEOR is an Australian web-based repository of nationally endorsed data and indicator definitions, hosted by the Australian Institute of Health and Welfare (AIHW).

Note: Exploration of the indicator data should include disaggregation of data by relevant clinical and demographic factors. This should include disaggregation by Aboriginal and Torres Strait Islander status and separate analysis of adult and paediatric patients. A list of ICD-10AM codes to identify patients coded for sepsis has been prepared to support use of the indicators.

Indicators for local monitoring

Quality statement 1 – Could it be sepsis?

Indicator 1a:

Proportion of patients with suspected sepsis who had blood lactate levels taken as a part of screening for sepsis.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755592

Quality statement 2 – Time-critical management

Indicator 2a:

Evidence of a locally approved sepsis clinical pathway. The pathway should include:

Criteria to support clinical decision-making to enable recognition of sepsis
Triggers and time frames for escalation to a clinician experienced in recognising and managing sepsis, higher levels of care or other healthcare services
Guidance on appropriate interventions and the timing of their use
Time frames for clinical review, including review of investigation results, response to treatment and the antimicrobial plan
Prompts to consider the patient’s age, cultural needs, goals of care and advance care plans
Prompts to consider alternative diagnoses.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755595External link

Indicator 2b:

Evidence of local arrangements that support the delivery of care described in the local sepsis clinical pathway. The local arrangements should specify the:

Multidisciplinary clinical governance processes for the pathway
Process to ensure access to the appropriate diagnostics, medicines and treatments required to implement the pathway
Process to enable escalation to a clinician experienced in recognising and managing sepsis 24 hours a day, seven days a week
Documentation requirements within the pathway and the patient’s healthcare record, including documentation of their final diagnosis
Process to ensure that clinicians using the pathway complete competency-based training on its use
Process to assess adherence to the pathway and its performance, including assessment of patient experience.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755597

Indicator 2c:

Proportion of patients with sepsis who were treated according to the locally approved sepsis clinical pathway.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755642

Quality statement 3 – Management of antimicrobial therapy

Indicator 3a:

Proportion of patients with sepsis who had blood cultures taken prior to starting antimicrobials.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755644

Indicator 3b:

Proportion of patients with signs and symptoms of infection-related organ dysfunction who started their first dose of an empirical antimicrobial within 60 minutes of recognition.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755646External link

Measurement of this indicator requires time of recognition and treatment to be collected. If these data are not currently available, consider using alternate indicators. Examples are provided in the METEOR link above.

Quality statement 4 – Multidisciplinary coordination of care in hospital

Indicator 4a:

Evidence of local arrangements to support multidisciplinary care coordination and clinical communication for patients with sepsis. The local arrangements should specify the:

Process to nominate a clinician experienced in sepsis management to coordinate the multidisciplinary care for each patient with sepsis while they are in hospital
Roles and responsibilities of each clinician working in the multidisciplinary team, including their responsibilities at transitions of care
Information that must be documented in the patient’s comprehensive care plan and healthcare records
Process to ensure that the patient’s care plan is shared with the patient, their carer and family where appropriate, and the relevant clinical team(s) or general practitioner at each transition of care
Services available to support effective, culturally safe communication and transitions of care
Process to assess adherence to the local arrangements.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755652