Example Treatment Escalation Plans
Symptoms
  • NOTE: Consider whether you need specific seperate TEPs for particular types or sites of infection or whether a "catch all" is sufficient. E.g. for COPD exacerbations or cellulitis, more specific management instructions and/or team contact details may be helpful. 
    Infection    TEP Level: ITU  Mx Plan: Consider source of infection & starting appropriate oral antibiotics. If deteriorating on oral antibiotics or not feasible, then admit to hospital for possible IV antibiotics. ITU admission will be decided in hospital as appropriate.
    Infection    TEP Level: Hospital  Mx Plan: Consider source of infection & starting appropriate oral antibiotics. If deteriorating on oral antibiotics or not feasible, then admit to hospital for possible IV antibiotics. Does not wish to be admitted to ITU
    Infection    TEP Level: Home  Mx Plan: Consider source of infection & starting appropriate oral antibiotics. Consider involving local community urgent response service/virtual ward/frailty team for further monitoring and support.
    If deteriorates despite oral antibiotics, consider whether this is an end of life situation. Move to comfort measures
    Infection    TEP Level: Comfort  Mx Plan: Consider source of infection & starting appropriate oral antibiotics, if feasible and wanted. Anticipatory meds. in place, use as required.
    Ensure Community Team supporting and Package of Care is sufficient for patient & family needs.
  • Delirium    TEP Level: ITU  Mx Plan: Investigate possible causes. Manage at home as appropriate. If deteriorating on oral treatment, then admit to hospital for further investigation. ITU admission will be decided in hospital as appropriate.
    NOTE: Consider whether appropriate if past history of dementia, a progressive neurological or palliative condition. Does patient have rehabilitation potential after active treatment.
    Delirium    TEP Level: Hospital   Mx Plan: Investigate possible causes. Manage at home as appropriate. If deteriorating on oral treatment, then admit to hospital for further investigation. Does not wish to be admitted to ITU.
    NOTE: See above. Patient, or family if LPoA for H&W is in place, may also wish to limit other treatments.
    Delirium    TEP Level: Home   Mx Plan: Investigate possible causes. Manage at home as appropriate. Ensure "Just in Case" meds and Admin orders are available. If deteriorates despite oral treatment, consider whether this is an end of life situation. D/W Palliative care, other involved Specialist Team or GP if not clear.
    NOTE: This option is only likely to be appropriate on a background of a palliative diagnosis or recurrent delirium & frailty. Seek specialist advice as appropriate.
    Delirium    TEP Level: Comfort   Mx Plan: Anticipatory meds. in place, use as required.
    Ensure Community Team supporting and Package of Care is sufficient for patient & family needs.
  • NOTE: Consider whether you need specific seperate TEPs for particular types or sites of infection or whether a "catch all" is sufficient. E.g. for COPD exacerbations or cellulitis, more specific management instructions and/or team contact details may be helpful. 
    Infection    TEP Level: ITU  Mx Plan: In
    Infection    TEP Level: Hospital  Mx Plan: In
    Infection    TEP Level: Home  Mx Plan: In
    Infection    TEP Level: Comfort  Mx Plan: In
    Treatment Escalation
    ​Level
    INFECTION (Chest/Urine/Unknown Source)​​
    Management Plan and Wishes :
    ITU
     ​​​Consider source of infection & starting appropriate oral antibiotics.
    If deteriorating on oral antibiotics or not feasible, then admit to hospital for possible IV antibiotics. ITU admission will be decided in hospital as appropriate.
    Hospital
    Consider source of infection & starting appropriate oral antibiotics.
    If deteriorating on oral antibiotics or not feasible, then admit to hospital for possible IV antibiotics. Does not wish to be admitted to ITU.
    Home
    Consider source of infection & starting appropriate oral antibiotics.
    Consider involving local community urgent response service/virtual ward/frailty team for further monitoring and support.
    If deteriorates despite oral antibiotics, consider whether this is an end of life situation. Move to comfort measures
    Comfort
    Consider source of infection & starting appropriate oral antibiotics, if feasible and wanted.
    Anticipatory meds. in place, use as required.
    Ensure Community Team supporting and Package of Care is sufficient for patient & family needs.
  • Delirium    TEP Level: ITU  Mx Plan: Investigate possible causes. Manage at home as appropriate. If deteriorating on oral treatment, then admit to hospital for further investigation. ITU admission will be decided in hospital as appropriate.
    NOTE: Consider whether appropriate if past history of dementia, a progressive neurological or palliative condition. Does patient have rehabilitation potential after active treatment.
    Delirium    TEP Level: Hospital   Mx Plan: Investigate possible causes. Manage at home as appropriate. If deteriorating on oral treatment, then admit to hospital for further investigation. Does not wish to be admitted to ITU.
    NOTE: See above. Patient, or family if LPoA for H&W is in place, may also wish to limit other treatments.
    Delirium    TEP Level: Home   Mx Plan: Investigate possible causes. Manage at home as appropriate. Ensure "Just in Case" meds and Admin orders are available. If deteriorates despite oral treatment, consider whether this is an end of life situation. D/W Palliative care, other involved Specialist Team or GP if not clear.
    NOTE: This option is only likely to be appropriate on a background of a palliative diagnosis or recurrent delirium & frailty. Seek specialist advice as appropriate.
    Delirium    TEP Level: Comfort   Mx Plan: Anticipatory meds. in place, use as required.
    Ensure Community Team supporting and Package of Care is sufficient for patient & family needs.
  • Infection    TEP Level: ITU  Mx Plan: In
    Infection    TEP Level: Hospital  Mx Plan: In
    Infection    TEP Level: Home  Mx Plan: In
    Infection    TEP Level: Comfort  Mx Plan: In
    Treatment Escalation
    ​Level
    INFECTION (Chest/Urine/Unknown Source)​​
    Management Plan and Wishes :
    ITU
     ​​​Consider source of infection & starting appropriate oral antibiotics.
    If deteriorating on oral antibiotics or not feasible, then admit to hospital for possible IV antibiotics. ITU admission will be decided in hospital as appropriate.
    Hospital
    Consider source of infection & starting appropriate oral antibiotics.
    If deteriorating on oral antibiotics or not feasible, then admit to hospital for possible IV antibiotics. Does not wish to be admitted to ITU.
    Home
    Consider source of infection & starting appropriate oral antibiotics.
    Consider involving local community urgent response service/virtual ward/frailty team for further monitoring and support.
    If deteriorates despite oral antibiotics, consider whether this is an end of life situation. Move to comfort measures
    Comfort
    Consider source of infection & starting appropriate oral antibiotics, if feasible and wanted.
    Anticipatory meds. in place, use as required.
    Ensure Community Team supporting and Package of Care is sufficient for patient & family needs.
  • Delirium    TEP Level: ITU  Mx Plan: Investigate possible causes. Manage at home as appropriate. If deteriorating on oral treatment, then admit to hospital for further investigation. ITU admission will be decided in hospital as appropriate.
    NOTE: Consider whether appropriate if past history of dementia, a progressive neurological or palliative condition. Does patient have rehabilitation potential after active treatment.
    Delirium    TEP Level: Hospital   Mx Plan: Investigate possible causes. Manage at home as appropriate. If deteriorating on oral treatment, then admit to hospital for further investigation. Does not wish to be admitted to ITU.
    NOTE: See above. Patient, or family if LPoA for H&W is in place, may also wish to limit other treatments.
    Delirium    TEP Level: Home   Mx Plan: Investigate possible causes. Manage at home as appropriate. Ensure "Just in Case" meds and Admin orders are available. If deteriorates despite oral treatment, consider whether this is an end of life situation. D/W Palliative care, other involved Specialist Team or GP if not clear.
    NOTE: This option is only likely to be appropriate on a background of a palliative diagnosis or recurrent delirium & frailty. Seek specialist advice as appropriate.
    Delirium    TEP Level: Comfort   Mx Plan: Anticipatory meds. in place, use as required.
    Ensure Community Team supporting and Package of Care is sufficient for patient & family needs.