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Sepsis: hospital setting (adults only)

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Sepsis is a life-threatening condition arising when the body’s response to an infection causes tissues and organ damage. Sepsis can lead to shock, multiple organ failure and death if not recognised and treated promptly. 
 
These questions will help to assess for sepsis in hospital inpatients. 
 
Question 1 
Does the patient look sick OR have they deteriorated? 
Question 2 
Could this be due to an infection? 
Question 3 
What is the National Early Warning Score (NEWS2)?
Question 4
Are any of the high risk criteria for sepsis present?

If any ONE high risk criteria is present, this may indicate sepsis.

High risk criteria for sepsis (tick all that apply)

  •  Systolic BP ≤ 90 mmHg (or drop >40 from normal)
  •  Lactate ≥ 2 mmol/l
  •  Respiratory rate (RR) >25
  •  Heart Rate (HR) >130
  •  New altered mental state
  •  Needs oxygen to keep SpO2 ≥92% (88% in COPD)
  •  Oliguria or not passing urine in previous 18 hours

 

What to do

  • Escalate to a senior health care professional immediately – start the NEWS2 observations every 30 minutes.
  • Escalate deterioration to a senior health care professional.
  • Ensure a competent practitioner undertakes the following within the hour:
  1. Administer oxygen – aim to keep saturations > 94% (88-92% if at risk of CO2 retention, eg, COPD).
  2. Take bloods to include cultures and lactate – One peripheral set. Consider microbiology samples, eg, CSF, urine, sputum.
  3. Give IV antibiotics as prescribed – according to trust protocol (considering allergies).
  4. Give IV fluid challenge as prescribed – if hypotensive/ lactate >2mmol/l. Check serial lactate regularly (arterial or venous)
  5. Measure urine output – commence hourly fluid balance chart (urinary catheter as required).

What to do outside an acute hospital setting

Escalate to the senior health care professional immediately (GP or medical team – consider A&E). Prompt recognition and initiation of treatment for all patients suspected of sepsis is vital. Depending on the care setting and skill level commence steps 1-3 immediately.

Please familiarise yourself with your hospital’s guidelines and procedures. For the most up-to-date guidance and information visit: rcn.org.uk/clinical-topics/infection-prevention-and-control/sepsis