Maternal Sepsis Pathway
Name Three Signs and Symptoms that could indicate Maternal Sepsis
Myalgia, back pain, general malaise, headache Unexplained abdominal pain, distension Vomiting, diarrhoea New confusion, change in behaviour or altered level of consciousness History of fevers, rigors or feeling cold Flu-like symptoms, cough, sputum, breathless Breast, wound or line redness, swelling, pain (including epidural block site) Dysuria, oliguria, frequency, odour
When is it appropriate to use the Neonatal Sepsis Pathway? (Age group)
Use the Neonatal Sepsis Pathway for neonates (babies up to 28 days corrected age) in any clinical setting to support recognition and management of sepsis
Is Sepsis a Medical Emergency?
Yes
If Someone Asks ' COULD IT BE SEPSIS?' what should be your response?
Listen
Look
Act
to recognise sepsis or rule it out
What are some of the actions that are included in the "resuscitate' section of the Maternal Sepsis Pathway?
1 - Get Help
2 - commence monitoring
3- Obtain Access and Collect Pathology
4 - Commence Fluid resuscitation
5 - Commence Antibiotics
Name three risk Factors for Maternal Sepsis
Recent surgery, procedure, wound At risk of intrauterine infection (prolonged rupture of membranes, prolonged labour, retained products of conception, fetal tachycardia) Immunocompromised, chronic illness Indwelling medical device or line Iron-deficiency anaemia Unwell children, household members Concern by woman, family, clinician Aboriginal and Torres Strait Islander people
What are three of the signs or symptoms that may alert you to possible sepsis?
Fever, hypothermia, temperature instability Pale, mottled, central cyanosis Lethargy, poor feeding, floppy / poor tone Apnoea(s) New or worsening signs of respiratory distress New rash, red umbilicus, cellulitis, joint swelling Seizure(s), abnormal movements, high pitched cry, irritability, increased tone, jitteriness Abdominal distension / tenderness, vomiting, diarrhoea, blood in stool
What are your actions for a red zone breach in the ISLHD Maternity Service
Rapid Response
Tier 1 - within 15 minutes
Tier 2 - Immediate
(Code Blue could also be indicated)
How many people develop sepsis each year in Australia?
a- 15000
b - 30000
c- 55000
d - 82000
55,000 people develop sepsis every year.
What pathology is collected on the ,Maternal Sepsis Pathway?
Lactate
FBC/ UEC / LFTs / Fibrinogen / Coagulation Screen / VBG & CRP
Blood Cultures
Other cultures ie swabs / MSU
Blood Glucose Level
On the Maternal Sepsis Pathway - What are the 4 sections?
- Recognise
- Respond & Escalate
- Resuscitate
- Reassess & Refer
What are two Maternal Risk Factors that are recognised are risk factors on the Neonatal Sepsis Pathway?
Prolonged Ruptured membranes
Maternal Pyrexia (above or equal to 380 C)
Maternal Infection
GBS
Bacterial Growth on a placental Swab
Increased sepsis probability on Neonatal Early Onset Sepsis Pathway
What Zone is a Maternal Temperature of 38.3o C on the Standard Maternal Observation Chart (SMOC)
Yellow Zone
How many people die from sepsis related complications each year in Australia
a - 1400
b - 8000
c - 1250
d - 2100
8000 of the 55000 people that develop sepsis each year in Australia, die from sepsis related complications
In the 'Commence Fluid resuscitation' section of the Maternal Sepsis Pathway what is recommended to be given as a bolus?
1000mls sodium chloride 0.9% STAT
You use the Maternal Sepsis Pathway from 12 weeks pregnant to 6 weeks postpartum. True or False
False - You use the Maternal Sepsis Pathway for all pregnant women and up to 6 weeks postpartum, including perinatal loss, in any clinical setting to support the recognition and management of sepsis
In the 'Resuscitation' section of the Neonatal Sepsis Pathway - What pathology should be collected?
Blood Cultures
Blood Gas
Lactate
Blood Glucose Level
What would be your action if a woman on the sepsis pathway had a lactate of 5 mmol/L
Rapid Response and refer to the Resuscitation plan
This woman has PROBABLE SEPSIS with a high risk of deterioration and SEPTIC SHOCK
Where do you find information about the Sepsis Kills Program?
The Clinical Excellence Commission website
the ISLHD Webpage
What are the recommended actions if there is ongoing hypotension?
Consider commencement of vasopressors and escalate to Intensive Care or Retrieval service
In the "resuscitate' section of the Maternal Sepsis Pathway: What are the two recommended actions that you should undertake in the first 5 Minutes
1. Get Help
Escalate as per local CERS
Consult with Obstetrician / Senior Clinician
2. Give oxygen as required to maintain SpO2 of 95% or above.
In the "Reassess' Section of The Neonatal Sepsis Pathway what ongoing monitoring is recommended?
Continue to monitor vital sign observations at a minimum frequency every 30 minutes for 2 hours, then hourly for 4 hours
When a Women is on the Maternal Sepsis Pathway how long do you continue to monitor her vital signs and fluid balance?
Minimum of every 30 minutes for 2 hours and then hourly for 4 hours. Escalate to CERS if any signs of deterioration
Where can I find some learning modules on Sepsis?
My Health Learning:
Lots of sepsis related courses including:
It is part of the Maternal Safety Education - Maternal Sepsis.
Emergency Module 13 - recognizing and responding to Sepsis
In the "reassess' Section of the Maternal Sepsis Pathway - What timeframe is recommended for a repeat lactate?
Within 2 hours