Sepsis in Hospitalized Patients – Grand Rounds

August 5, 2019

The cases of sepsis in hospitalized patients is expected to grow as the baby boomer generation ages in the next ten years. Between 60-85% of sepsis cases occur in patients 65 and older due to a weaker immune function and resistance.

The latest installment in the College of Community Health Sciences Grand Rounds Lecture Series focused on a sepsis case with concerns of elder abuse that epitomized the need for interdisciplinary and professional cooperation between medical professionals, social workers and case managers, and lawyers.

Sepsis is the result of harmful microorganism in the bloodstream or other tissues and the bodies resulting attempts to combat the infection triggering inflammation throughout the body. Sepsis can lead to septic shock, multiple organ dysfunction (MODS), and death. The severity of case can progress at an alarming rate.

A fever is often a sign of sepsis and Drs. Brittany McArthur and Jackie Luker, geriatrics fellows at The University of Alabama Geriatrics Fellowship Program, stressed the need to remember that in an elderly patient a fever can be redefined as two degrees over the baseline, a single oral temperature of over 100 degrees or repeated oral temperatures of over 99 degrees.

The source of the patient’s infection was from pressure ulcers leading to concerns of elder abuse in the community home where he was residing. Pressure ulcers can occur anywhere the body touches a surface. A case manager and lawyer were consulted in regard to the patient’s outcome and placement.

Allyson Gold, JD, an assistant professor of clinical legal instruction and director of the Elder Law Clinic at The University of Alabama, discussed the importance of having the proper paperwork in place for a living will, last will and testament, power of attorney for healthcare and durable power of attorney.

A durable power of attorney remains in effect even if the individual becomes incapacitated. The agent can make financial and healthcare decisions for the individual in the long term if a DPOA is signed. It is crucial for older patients to choose an agent to act as DPOA with no conflicting interests.

In the example case at grand rounds, the patient had selected the caregiver at the community home, which raised concerns of whether the agent was acting the best interest of the patient.

The College’s Grand Rounds series, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process. In this case doctors were encouraged to know the resources available for the patient including social work, case management, nurses, physicians, human resources and the law clinics.