Sepsis and Sepsis Six - Observation Chart

Patient Name:								Hospital Number:
Date ()
Time	17.50	19.00	20.00	20.05	20.15	20.30	21.00	22.00	00.00	02.00	04.00	05.00	06.00	08.00	09.00
Blood pressure mmHg <--------------> Pulse per minute () >160 160 150 140 130 120 110 100 90 80 70 60 50 40






		↑												↑ ¦
		¦						↑	↑ ¦	↑		↑	↑ ¦	¦
		¦	↑	↑			↑	¦	¦ ¦	¦ ¦	↑	¦ ¦	¦	¦ ¦	↑
	↑	¦	¦	¦		↑	¦ ¦	¦	70	72	¦	70	¦	70	¦
	¦	¦	¦	64		¦	60	68	¦	¦	65	¦	68	¦	65
	¦	↓	¦	¦		¦	¦	¦ ¦	¦	¦	¦ ¦	¦	¦ ¦	¦	¦
	¦		↓	¦		↓	↓	↓	↓	↓	↓	↓	↓	↓	↓
	↓			↓
Temperature	38.4	38.0		38.1	38.1		38.0	37.6	37.2	37.0	37.2	37.0	36.4	36.6	36.6
CVP/GCS	P	V	V	V	P		10/V	10/V	10/A	10/A	7/A	10/A	10/A	12/V	14/V
RR (per min)	25	24	24	27	26		25	24	24	24	26	28	30	32	34
Oxygen Sats (%)	99	99	99	99	98		98	98	95	95	94	92	90	92	89
Oxygen delivery % / Litres	15 L	15 L	15 L	15 L	15 L		40	40	40	40	40	40	40	60	60
O2 device on air (A)	NRM	NRM	NRM	NRM	NRM		CH	CH	CH	CH	CH	CH	CH	CH	CH
Blood sugar (mmols)				11.5			8.0	7.6	6.5	6.3	6.2		5.9	5.8
EWS Score	Individual scores for each observation and total score \| Check against EWS criteria
Temp	2	0		2	2		0	0	0	0	0	0	0	0	0
Systolic BP	3	0	2	2	3		2	1	0	1	1	1	0	0	2
HR	2	2	2	1	2		1	1	1	1	1	1	2	2	2
RR	2	2	2	2	2		2	2	2	2	2	2	3	3	3
Oxygen %	3	3	3	3	3		1	1	1	1	1	1	1	3	3
Neuro (AVPU)	2	1	1	1	2		1	1	0	0	0	0	0	1	1
Urine	0	0	0	0	0		1	2	2	1	2	1	1	2	3
Total EWS Score	14	8	10	11	14		8	8	6	6	7	6	7	11	14