Indicators for the Sepsis Clinical Care Standard

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

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/755595

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

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/755646

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.

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

Indicator 5a:

Proportion of patients with sepsis who reported they were kept informed as much as they wanted about their treatment and care.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755654

• See Indicator 4a above

Indicator 6a:

Proportion of patients with sepsis who had a diagnosis of sepsis recorded in their discharge summary.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755656

Indicator 7a:

Proportion of patients with sepsis who had an unplanned readmission for any cause to any hospital within 30 days of discharge.

METeOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755658

Indicator 8a:

Proportion of patients with sepsis who died during their inpatient episode of care.

METEOR link: meteor.aihw.gov.au/content/index.phtml/itemId/755660

The Antimicrobial Stewardship Clinical Care Standard has a number of relevant indicators such as:

• Use of guidelines (indicator 2a)
  • The proportion of antimicrobial prescriptions that are in line with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines
• Documentation (indicators 6a and 6b)
  • The proportion of prescriptions for which the indication for prescribing the antimicrobial is documented
  • The proportion of prescriptions for which the duration, stop date or review date for the antimicrobial is documented
• Review of therapy (indicator 7a)
  • The proportion of prescriptions for which an antimicrobial review and updated treatment decision is documented within 48 hours from the first prescription

Detailed specifications for the Antimicrobial Stewardship Clinical Care Standard are available on the Metadata Online Registry at https://meteor.aihw.gov.au/content/index.phtml/itemId/736878

A hospital-acquired complication (HAC) refers to a complication for which clinical risk mitigation strategies may reduce (but not necessarily eliminate) the risk of that complication occurring. The HACs list comprises agreed, high-priority complications for which clinicians, managers and others can work together to address and improve patient care. Each of the HACs has a number of associated diagnoses and codes, which allow further exploration of the data. Data for HACs are derived from the admitted patient data collection.

The Commission has developed several resources for clinicians, managers and executives, governing bodies and others that can help them put in place strategies that reduce the occurrence of HACs. These are available on the Commission’s website.