Sepsis Recognition & Management

Four words, and they are the whole course. Quality statement 1 of the Australian Sepsis Clinical Care Standard is not a requirement. It is a question: could it be sepsis? — and it has to be asked out loud.

It reads: a diagnosis of sepsis is considered in any patient with an acute illness or clinical deterioration that may be due to infection. Not confirmed. Not scored. Considered — a far lower bar than most clinicians set for themselves before they will say the word in front of a colleague. Every other statement in the standard depends on somebody having asked that one first.

And the programme holds both halves of the antimicrobial timing framework. In septic shock and in probable sepsis, immediately — ideally within one hour. In POSSIBLE sepsis without shock, rapid investigation with antimicrobials within three hours if concern persists. And where the likelihood of infection is low and there is no shock, defer. Which half applies is decided by certainty, not by the clock.

It carries no antimicrobial agent, dose, route or duration, no fluid volume and no vasopressor. Those belong to the current Therapeutic Guidelines, your service's antimicrobial formulary and a prescriber.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Sepsis is life-threatening ORGAN DYSFUNCTION caused by a dysregulated host response to infection. Organ dysfunction is the core of it. Without that, you have an infection — which is why organisms in the blood are neither necessary nor sufficient, and why severity of symptoms is not the definition.

'Severe sepsis' was eliminated. The old three-tier structure made plain sepsis sound like the one you could watch, and it was removed with the stated goal of earlier recognition and more timely management. A local document still using the term predates the current definitions.

And there is no single diagnostic test. Sepsis is a clinical diagnosis presenting as a spectrum, so there is nothing for a binary test to detect. The standard's resolution is one sentence: although there may be uncertainty, the potential for rapid and serious deterioration necessitates intervention whenever sepsis is a possibility.

The module also introduces the distinction that sets the clock in Module 06 — probable against possible sepsis.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Who the question gets asked about, and it is a wider net than most services cast. Any patient with an acute illness or clinical deterioration that MAY be due to infection. No temperature threshold, no confirmed source, no requirement that a tool has triggered.

The observations the standard names include two that are not numbers. Altered mentation, behaviour change or delirium, listed alongside the vital signs rather than beneath them. And poor peripheral perfusion — cool peripheries, delayed capillary refill, mottled skin — which requires a hand on the patient, and is the first casualty of a busy round. The third weak point is the respiratory rate, which moves first in sepsis and is the observation most often estimated rather than counted.

Family or carer concern is listed FIRST among the red flags, and it is evidence-cited. The module finishes with documentation: 'query sepsis, source possibly urinary' is a different entry from 'query UTI', and it is the one that survives a handover.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

The module that decides whether the rest of the course is any use. In older people, the commonly recognised signs of sepsis are OFTEN ABSENT. They are more likely to have relative immunosuppression, and less likely to have a fever, a raised white cell count or a raised C-reactive protein. What appears instead is hypothermia, delirium, and falls in frail people — so a fall in an older person with a possible infection is a presentation of sepsis until somebody has asked the question.

In children, hypotension is NOT necessary to diagnose septic shock. A normal blood pressure in a very unwell child is the compensation still holding, not reassurance.

In pregnancy the normal physiology has already moved two of the parameters a tool watches, and for neonatal and maternity patients a decision support tool may not exist — in which case the standard says early assessment and escalation are the priority. Beta blockers, corticosteroids, immunosuppressants and antipyretics each remove a signal without producing an alert on any chart.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Two instruments, and the same error is available in both.

Lactate is named in quality statement 1 — and the same document says it is NOT SUFFICIENT for the purpose of diagnosis. Include it routinely in decision-making for a deteriorating patient; test it where this will not delay urgent care; and note that a raised level may reflect a protective OR a maladaptive response, which is why it screens rather than diagnoses.

Clinical support tools do not replace clinical judgement, and no single tool applies to everyone. A tool that does not trigger tells you the tool did not trigger — and remember Module 03: it is watching for signals that are less likely to be present in the patients with the highest sepsis mortality.

The phrase worth deleting from your documentation is 'sepsis screen negative'. It converts a screening result into a diagnosis, and it is one of the commonest entries preceding a delayed recognition. Also here: what point-of-care lactate changes in rural and remote settings, and why calling criteria are not widened to stop an alarm.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Sepsis is a time-critical medical emergency. Quality statement 2: assessment and treatment of a patient with suspected sepsis start urgently under a locally approved clinical pathway; the response to treatment is monitored and reviewed; the patient is reviewed by a clinician experienced in recognising and managing sepsis; and they are escalated to a higher level of care when required.

The module works through the six elements the standard says a pathway must contain — and four of the six are about movement and time rather than treatment. Then the escalation architecture that has to exist 24 hours a day, seven days a week, including a route to emergent transfer, and the requirement that investigations and treatment start before transfer.

And the sentence written for primary and community care: if diagnosing or managing sepsis is outside your scope of clinical practice, the most appropriate action may be the immediate referral of the patient to hospital. You do not have to be able to manage sepsis in order to act on the possibility of it.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

The module the whole course is built around. Quality statement 3 has two halves and most teaching carries one.

Blood cultures immediately, ensuring that this does not delay the administration of appropriate antimicrobial therapy. Antimicrobials within 60 minutes when signs of infection-related organ dysfunction are present. And therapy managed in line with the Antimicrobial Stewardship Clinical Care Standard, including a review within 48 hours from the first dose.

Then the timing framework by certainty. Septic shock, and probable or definite sepsis: immediately, ideally within 1 hour — both STRONG recommendations. POSSIBLE sepsis without shock: a time-limited course of rapid investigation, with antimicrobials within 3 hours if concern persists. And where the likelihood of infection is LOW and there is no shock: defer, while monitoring closely.

Teaching only urgency produces antimicrobial overuse. Teaching only stewardship produces hesitation at the bedside of a shocked patient, which is the more lethal error. No antimicrobial agent, dose, route or duration appears anywhere in this module.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Family or carer concern is named FIRST among the red flags in the standard, and it is not a courtesy item. The standard states it is well demonstrated that a high level of family or carer concern warrants investigation, and states — with a reference — that cases of sepsis have been missed due to clinicians not listening to the concerns of patients, their families or carers.

The commonest objection is that families will misuse a direct escalation route. That has been tested: a systematic review of patient- and family-activated escalation found that ALL calls included were deemed appropriate. And it is a governance requirement — Action 8.06 puts worry or concern into the escalation criteria, in the workforce as well as in families, and Action 8.07 requires a route for patients and families to escalate directly.

Then quality statement 5, which runs the other way: the patient and family are informed about sepsis from the time that it is suspected, in a way they can understand, verbally and in writing.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Two quality statements answering the same question from opposite ends. Statement 4: sepsis is a complex, multisystem disease, and treatment in hospital is coordinated by a clinician with expertise in managing patients with sepsis. A condition involving five organ systems at once has no natural owner unless somebody is given it.

Statement 6: a patient with known or suspected sepsis has a documented clinical handover at transitions of care, including the provisional sepsis diagnosis, comorbidities, and the management plan for medicines and medical conditions — and that information goes to the patient, family and carer as appropriate.

The failure mode is specific. 'Query sepsis, possible urinary source' becomes 'UTI'; the source survives and the syndrome vanishes. And a provisional diagnosis lost between two clinicians does not reset the clock in the guideline — the three-hour position runs from when sepsis was FIRST SUSPECTED. The module finishes with the one-sentence handover that carries everything, including the times.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Quality statement 7 exists because surviving sepsis is not the end of it. Survivors face complications, higher costs, longer treatment, and a risk of rehospitalisation and recurrence. The standard requires individualised follow-up to optimise functional outcomes, minimise recurrence, reduce rehospitalisation and manage the ongoing health effects — structured, holistic and coordinated care involving the patient, their family, carer and general practitioner.

What people actually report is fatigue that does not resolve, breathlessness, muscle weakness, poor concentration and memory, disturbed sleep and low mood. And many were never told they had sepsis, so they interpret a well-described post-sepsis picture as a personal failure to recover properly from 'a chest infection'.

The discharge communication has to say the word, the service must address barriers to continuing antimicrobials including cost, and the Commission publishes bereavement support material as part of this standard — because not everybody survives.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

The eleven indicators the Commission publishes for local monitoring, and what each actually measures. Three of them measure whether anything was written down — including indicator 6a, the proportion of patients with sepsis who had a diagnosis of sepsis RECORDED in their healthcare record. If the word is not there, nothing downstream of it can happen.

And a warning about using them. An audit of patients CODED with sepsis measures the patients you already recognised. The recognition failures are in the other pile — coded as pneumonia, urinary tract infection, delirium or a fall.

Sepsis care runs on four existing NSQHS standards: Actions 8.01, 8.04, 8.06 and 8.07; 3.18 and 3.19 for stewardship; 5.05 and 5.10; and 6.11 for handover. Then the scope matrix, in which asking the question and escalating is every row, the NMBA decision-making framework, what the service owes as distinct from what you do, and the ten local questions this course deliberately leaves to you.

In this section: the module slide deck, the student learner guide, and the knowledge check. The check is formative - not graded, no attempt limit - and the rationale on every option is the content.

Two components. The case study assessment is five unfolding situations with branching decisions; every option carries feedback, including the plausible wrong ones, which is where most of the learning is. Completion is required and it is not graded.

The summative assessment is 60 single-best-answer items across all eleven modules, at a 80 per cent pass mark with two attempts. The certificate is issued automatically on a pass.

Twenty items are mandatory-correct. They test the knowledge where an error causes serious and avoidable harm — the three in Module 06 most of all, because a learner who leaves believing antimicrobials go in within one hour for every possible infection has been made a driver of antimicrobial overuse, and one who leaves believing investigation comes first for everybody will hesitate at the bedside of a shocked patient.

Five optional drills. Nothing here is graded, nothing is recorded anywhere, and you can go round each set as often as you like.

Could it be sepsis? Twelve presentations — and several are not sepsis, where asking is still correct. What is the clock? Twelve patients across all four rows of the timing framework, including the row where the guidance says defer. What do you do next? Twelve bedside situations, several with a service-level answer. Listen or reassure? Twelve things people say to you, and none is answered by reassurance. Sepsis scope self-check. Sort every activity in the programme against your own role.

These are excluded from the claimable CPD figure because they are optional. If you complete them, claim that time as additional self-directed CPD.

Three fillable instruments for use at work rather than in the course. None of them is a compliance audit, and each says so on its face — a form that looks like one gets reported as one.

The sepsis pathway walk-through rehearses your own pathway in advance, with a stopwatch: can you find the tool, who is the experienced clinician at 3am, and how long does a first dose actually take out of hours against the 60-minute requirement. The times are the finding.

The sepsis recognition review record reconstructs what was observed, what was asked and what was escalated — as a review of CONDITIONS. No names, roles and times only, because late recognition is overwhelmingly a system finding.

The sepsis survivorship discharge checklist starts with the line that matters most: has the word sepsis been said to the patient, in plain language? It also carries the cost question, because the standard names cost as a barrier the service must address.

Reference material to keep rather than to work through. The scope of practice card is one page to print — the observations, the red flags, the patients who do not look septic, all four rows of the clock, and a list of things never to do. The further reading and organisation directory carries the Australian and international sources with live links.

Note the two currency layers. The ACSQHC Sepsis Clinical Care Standard (June 2022) is the current Australian document and governs Australian practice. The Surviving Sepsis Campaign guidelines beneath it were updated in 2026, and that update extends rather than contradicts the standard. Where this programme cites one rather than the other, it says which.