Patients who don't trigger the escalation criteria
's situation meant her condition changed to one of high (red) risk. However, if your patient doesn't reach high (red) risk criteria then what do you need to do to ensure you give the treatment and care that they require?
In any patient deteriorating with either moderate (amber) or high (red) risk of death from sepsis, it is vital to assess the effectiveness of any intervention. Ensure that close monitoring continues as, although initial response may be observed, it is important to review whether that improvement has continued.
You would need to continue to investigate the cause of the problem, establishing an appropriate diagnosis, continuing the infection screening: requesting investigations, (e.g. radiology chest x-ray, etc.), sending samples, (e.g. urine, wound swabs) and chasing results in order to analyse these.
Fluid status: Where a patient has responded to a fluid challenge, it is important to continue assessing this and ensure that ideally oral fluids can be used to maintain hydration levels.
Results from the swabs and cultures taken may be starting to return depending on the tests undertaken. So, antibiotics can be reviewed in light of the sensitive organisms, ensuring these are targeted.
Microbiology concerns are ongoing. Whilst the tazocin was given early in this case study, there is a need to review all antibiotic use. Antibiotic usage is essential in minimising the problems of infection, however inappropriate usage needs to be minimised.
Hydration assessment needs to continue.
Sepsis "must be treated promptly with effective antibiotics. This is another important reason why we must tackle and reduce antibiotic resistance so that the first choice antibiotics can work in those who need them".
Please follow the link here for Higher Education England (HEE) e-learning on Reducing Antimicrobial Resistance.
Further management of will depend on additional clinical assessment, the findings from investigations undertaken, her response to the treatments already given and the clinical judgement of the medically qualified practitioner undertaking the review.
*Select image to view enlarged
[Figure from Start Smart - Then Focus: Antimicrobial Stewardship Toolkit for English Hospitals]