NT Health Sepsis Management Plan
Management plan to strengthen sepsis identification and
treatment for NT Health patients
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Department of Health is a Smoke Free Workplace
Overview
Sepsis is five times more common in the NT than more temperate climates.
According to a Royal Darwin Hospital based study from 2011, about 1000 adults per year present to the emergency department (ED) and half of these (50.7%) are Aboriginal people. The age- adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4%), but for Aboriginal people it was 40.8 per 1000 (mortality rate, 5.7%).
An NT Health review of coronial findings, between 2009 and 2019, identified five inquests in which the NT Coroner has made recommendations to NT Health relating to sepsis management..
At the recommendation of the NT Health Clinical Governance Committee, the Northern Territory Health Oversight Committee (NT HOC) and the Chief Executive invited a site visit by the NSW Clinical Excellence Commission (CEC) in May 2019 to implement sustainable quality improvement initiatives.
The CEC recently provided their report with 23 recommendations for the Northern Territory to strengthen sepsis recognition and management.
In response to this report, the Chief Executive requested that a sepsis management plan be developed to implement these recommendations and strengthen sepsis recognition and management in the NT.
Northern Territory Health Sepsis Working Group
In order to review and implement the recommendations forwarded by the CEC a Northern Territory Health Sepsis Working Group must be formed.
Governance
A dedicated Sepsis Working Group will be formed to work through the 23 recommendations from the CEC consultation. This working group will report to the NT Health Clinical Governance Committee (NT CGC).
The Sepsis Working Group will consist of staff based in, the Central Australia Health Service (CAHS) and Top End Health Service (TEHS), and from the Department of Health.
The Sepsis Working Group will be chaired by the Chief Health Officer, with senior clinician support from health services.
The Sepsis Working Group will prioritise, lead and oversee implementation, and facilitate communication across NT Health.
Senior clinician Sepsis Working Group members will liaise with Health Services to provide ongoing updates on working group initiatives and outcomes of audit and review.
Any changes to NT Health policy will require another level of governance, and must be submitted to NT HOC for approval.
Proposed Sepsis Working GroupDeliverables Three-Month Deliverables:
• Finalise working group terms of reference and membership
• Prioritise the recommendations from the CEC NT Sepsis Management Review and establish a working group action plan. Report the action plan to the Chief Executive.
• Implement a communication plan including planned education materials and artwork
• Agree on and establish a reporting framework
• Agree on key performance indicators for data collection and commence baseline data collection.
Six-Month Deliverables:
• Produce six-month program report for the NT CGC and Chief Executive in accordance with the action plan
• Baseline data collection to be completed Twelve-Month Deliverables:
• Produce 12-month program report for the NT CGC and Chief Executive in accordance with the action plan
• Reporting framework to be in place
• All CEC recommendations from the CEC NT Sepsis Management Review implemented Eighteen-Month Deliverables:
• Review program effectiveness based on established key performance indicators and baseline data collection.
Proposed Working Group Milestones
• Development of an NT Health Sepsis Management Pathway
• Development of an NT Health Sepsis Education Plan which includes a detailed strategy for Aboriginal health
• Development of a Community Sepsis Awareness Plan in collaboration with the T for Thomas Foundation
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Department of Health is a Smoke Free Workplace
Project Schedule
The NT Health Sepsis Working Group will be accountable for a six-month and twelve-month batch of deliverables. These will be reported to the Northern Territory Clinical Governance Committee and the Chief Executive, as well as the Northern Territory Health Oversight Committee when a change to health policy is recommended.
Priorities for the Sepsis Working Group will be based on recommendations from the CEC NT Sepsis Management Review, with support from the NSW CEC Sepsis Management Toolkit.
Impact Measurement
Evaluation of the effect of the NT Health Sepsis Management Plan will be based on key performance indicators determined by the Sepsis Working Group. These may be based on:
• the NSW CEC Therapeutic Advisory Group Quality Use of Medicines Indicators
• indicators from the CEC Sepsis Toolkit
• the Australian Sepsis Network guiding principles
• the ACSQHC National standard for preventing and controlling healthcare associated infections and other ACSQHC initiatives.
Indicators determined by the Sepsis Working Group must have clear criteria for assessment so that they are standardised and comparable across the health services.
KPI measurement should occur in small, manageable audits. This will both monitor for trends in performance and prevent significant interruption to Health Services business compared with large annual audits.
Summary
Given the high rate of sepsis and the serious impact associated with the disease, development of a clear and coordinated sepsis management plan is essential for NT Health.
Similar programs have been run in other Australian states and internationally with significant improvements in patient mortality and reduced lengths of admission.
As sepsis can occur anywhere in a patient’s journey this project should be managed by the Department of Health with engagement from key clinicians across TEHS and CAHS This management plan recommends the following:
• A Northern Territory Health Sepsis Working Group must be formed to conduct all relevant policy, to plan development and to ensure there is support to facilitate consistent sepsis management practice at all NT Health sites.
• The Sepsis Working Group will act as a conduit between the Northern Territory Health Clinical Governance Committee and relevant TEHS and CAHS functional groups and committees to communicate changes to sepsis management and implement change
• The schedule for the Sepsis Working Group must be based around the recommendations provided by the CEC NT Sepsis Management Review document and information for implementation provided in the NSW CEC Sepsis Toolkits.
• The success of the Sepsis Working Group and the Sepsis Management Plan will be evaluated using indicators provided by the NSW CEC Therapeutic Advisory Group Quality Use of Medicines Indicators, the Australian Sepsis Network guiding principles, the CEC Sepsis Toolkit and the National Standard for preventing and controlling healthcare infections.
