Hospice Care for Sepsis/Septic Shock
Sepsis is different from other serious or chronic diseases that often lead to a hospice diagnosis because of the speed at which it develops. If not treated and addressed quickly, a sepsis-related infection can spread quickly throughout the body and worsen, often within a matter of hours or a few days. As soon as sepsis is diagnosed, it should be brought to the immediate attention of hospice admissions personnel, because that’s when VITAS can help.
What is sepsis or septic shock?
Sepsis is a life-threatening condition that arises when the body’s immune system responds inadequately to an infection, a response that damages the body’s own tissues and major organs. Most sepsis-related infections are caused by bacteria, but they can also stem from fungi, viruses or parasites. The bloodstream, lungs, brain, urinary tract, skin and abdominal organs are the most common locations for a primary sepsis infection.
Sepsis is classified into three stages, and if a referral to hospice is necessary, it should be made quickly.
1. Sepsis is the initial infection, which sets off an inflammatory immune response that affects the entire body. Most people recover from mild sepsis if antibiotics, fluids and supportive treatments are started early, preferably within hours of diagnosis.
2. Severe sepsis impacts and impairs blood flow to vital organs, including the brain, heart and kidneys. It can also cause blood clots to form in internal organs, arms, fingers, legs and toes, leading to varying degrees of organ failure and gangrene (tissue death). Among hospitalized patients, sepsis is the leading cause of death (34%).1 Symptoms of severe sepsis include:
- Difficulty breathing
- Kidney damage (marked by lower urine output), liver damage and other metabolic changes
- Delirium/changes in mental status
- Excessive bleeding
- Increased levels of lactate in the blood
3. Septic shock evolves when severe sepsis produces a dramatic drop in blood pressure.
Doctors rely on a variety of factors and tests to identify the source of the infection and diagnose sepsis, including temperature, heart rate, respiratory rate, blood/platelet counts, biomarker analysis and other cultures/tests.
Who is most at risk for sepsis or septic shock?
Some patients are more susceptible than others, including those who:
- Are very young or very old
- Are suffering from a chronic illness or a drug-resistant bacterial infection
- Have weakened immune systems from HIV, cancer treatments, transplant drugs, diabetes or major trauma
- Have underlying illnesses (40% of hospitalized patients) that would make them eligible for hospice care, including advanced cancer, heart failure, advanced lung disease (shortness of breath at rest or with minimal exertion, with or without oxygen), and dementia accompanied by any difficulty with activities of daily living (eating, bathing, dressing, toileting, personal hygiene, etc.)
- Rely on invasive devices, including intravenous catheters, breathing tubes or ventricular assist devices for the heart
What patients and families should know about sepsis, and how hospice can help
Patients are eligible for hospice care when a physician makes a clinical determination that life expectancy is six months or less if the condition or disease runs its expected course.
Many sepsis infections, however, occur in patients who are already seriously ill, hospitalized, in the intensive care unit (ICU) or recovering from a hospital procedure. However, elderly or debilitated patients may be successfully managed and discharged to outpatient care to only begin a persistent and progressive decline from the latent effects of this insidious disease. Ideally, patients who develop sepsis and have survived the initial hospitalization from sepsis, but are now experiencing decline, should be evaluated for participation in goals-of-care conversations. These conversations serve to identify their preferences for end-of-life care. If eligible, hospice care is the most care these individuals can receive at home.
Hospice admissions personnel should be contacted immediately when severe progressive sepsis is diagnosed, because time is of the essence when a potentially rapid, progressive infection occurs late in the disease progress or in patients whose health is already unstable or compromised. If sepsis does not result in the patient’s death, hospice care may be the best option to manage long-term symptoms, address pain and support the patient and family.
Here are some tips for families and patients who face the challenges of serious illness, hospitalization or numerous procedures that put them at risk of sepsis:
- Read and share "Considering Hospice: A Discussion Guide for Families."
- Make your wishes known now: Talk about them, write them down, share them. If you are a patient at risk for sepsis, make sure to document your wishes and preferences for end-of-life care now, before a crisis arises. Decide what interventions you want and do not want if you face a life-limiting diagnosis or a potentially deadly infection like sepsis. When you have completed advance directives, such as a living will or durable power of attorney for healthcare decisions, your family, healthcare proxy and healthcare team can make decisions about end-of-life care without disagreement or guilt.
1 Rhee C., et al. “Prevalence, Underlying Causes and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals.” JAMA Network Open. 2019;2(2):e187571