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Put sepsis at the forefront

14 Aug 2023

RN, RM and Remote Clinical Educator at CRANAplus, Leonie McLaughlin, is passionate about helping nursing staff in remote communities provide best-practice care in the absence of maternity services and care providers. Here, she discusses CRANAplus’ recently updated Maternity Emergency Care (MEC) and Midwifery Upskilling (MIDUS) courses and why sepsis needs to be front of mind.

There are not a lot of mid­wives in remote loca­tions and so remote area nurs­es (RANs) often have to step up and look after preg­nant women, new mums and their babies out­side their nor­mal scope of prac­tice,” says Leonie.

One of our major goals at CRANAplus is to pro­vide sup­port to these remote nurs­es, by pro­vid­ing them with the skills, tools and infor­ma­tion they need to be con­fi­dent in their assess­ment and col­lab­o­ra­tive care of the peri­par­tum woman.”

Along with her col­league Aman­da For­ti, Leonie coor­di­nates more than 30 MEC and MIDUS cours­es through­out the year across Australia. 

The pair have spear­head­ed recent course updates, such as more inter­ac­tive, hands-on learn­ing in the MEC course and addi­tion­al course and pre-course learn­ing material.

We cov­er emer­gency and co-mor­bid­i­ty sit­u­a­tions in mater­ni­ty, but also the nor­mal aspects of ante and post­na­tal care,” Leonie explains, such as the skills to con­duct a thor­ough assess­ment for preg­nant women, under­stand­ing the nor­mal preg­nan­cy, birth and post­na­tal period.

This is often bread and but­ter’ for these RANs in con­sul­ta­tion with their local mater­ni­ty care providers, and, impor­tant­ly, then enables the RANs to iden­ti­fy vari­a­tions from nor­mal, and to esca­late care in a time­ly manner.”

One such vari­a­tion is sep­sis. As defined by the Sep­sis Alliance, sep­sis is the body’s over­whelm­ing and life-threat­en­ing response to infec­tion that can lead to tis­sue dam­age, organ fail­ure, and death… Sep­sis can lead
to severe sep­sis and sep­tic shock.’

Sep­sis is now a major focus in CRANAplus’ recent­ly updat­ed MEC and MIDUS cours­es. Ear­ly recog­ni­tion and com­mence­ment of treat­ment are vital; dou­bly so in a low-resource remote set­ting where
help is fur­ther away.

It’s all very well for the nurse to have the skills to assess and con­sult, but pro­vid­ing treat­ment in the first hour and get­ting the patient to the hos­pi­tal are also key pri­or­i­ties,” Leonie says.

As per the sep­sis guide­lines and path­ways, we encour­age nurs­es to always con­sid­er sep­sis as a pos­si­bil­i­ty in any pre­sen­ta­tion, and to keep at the front and cen­tre of their mind: Could this be sepsis?’

In mater­ni­ty care, one of the things preg­nant women can present with may appear to be pneu­mo­nia or a uri­nary tract infec­tion. With a post­na­tal patient, it could be mas­ti­tis, a wound, or retained prod­ucts – but always, Could this be sepsis?’”

annaperevozk­i­na — stock​.adobe​.com.

Leonie says there is an excel­lent array of resources and infor­ma­tion avail­able online to help clin­i­cians iden­ti­fy and man­age sep­sis (refer to the box below). 

On each course, we may have 24 par­tic­i­pants, all from remote com­mu­ni­ties, and each sit­u­a­tion can be dif­fer­ent,” says Leonie. 

These par­tic­i­pants are our peers, and they are often very, very expe­ri­enced nurs­es and mid­wives, who need to trans­late what needs to be done into their own settings. 

The more gener­ic ques­tions we share are so impor­tant. Ques­tions like: Do I have a birthing box?’ What drugs do we have on hand?’ Are they in date?’ Who is in charge of check­ing these resources?’

When our course par­tic­i­pants go back to work, we encour­age them to review their local pro­to­cols, equip­ment and resources. 

We’ve had par­tic­i­pants report that, on check­ing, they’ve dis­cov­ered drugs that are well out of date, and birthing kits that need re-ster­il­is­ing or refreshing.

This course gives par­tic­i­pants the oppor­tu­ni­ty to pause for thought, to think about their pro­to­cols and their birthing kits, neona­tal resus equip­ment, oth­er equip­ment and resources for mater­ni­ty care, and how they will pre­pare for and respond to the pre­sen­ta­tion of a peri­par­tum woman.”

More infor­ma­tion on sepsis

  • Sep­sis Aus­tralia aus​traliansep​sis​net​work​.net​.au
  • Aus­tralian Com­mis­sion on Safe­ty and Qual­i­ty in Health Care pro­vides back­ground infor­ma­tion on the Nation­al Sep­sis Pro­gram and the Nation­al Sep­sis Aware­ness Campaign
  • Aus­tralian Col­lege of Nurs­ing runs sep­sis courses
  • The Clin­i­cal Excel­lence Com­mis­sion (NSW Gov­ern­ment) offers sep­sis tools, pub­li­ca­tions, path­ways and a Sep­sis Kills pro­gram to improve recog­ni­tion and treat­ment and reduce pre­ventable harm to patients with sepsis.

To reg­is­ter for an upcom­ing MEC or MIDUS course, vis­it CRANAplus Face-to-face Cours­es.