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Policies used to support the treatment and care of a patient with sepsis (UK based)

You have reached the end of the case study scenario. This next section aims to look at some major policy drivers that inform the treatment and care that a patient with suspected sepsis should receive. These should be seen alongside your local hospital policies. Always refer to your local hospital policy guidelines in addition to the NICE guidelines.


Identify at risk group
Consider any signs or symptoms that may suggest an infection is present
Take history from patient and/or relative


Start with assessing high (red) risk category, then moderate (amber) and then low (green) risk category

  • Mental state: AVPU, functional ability, rigors
  • Breathing: rate, rhythm, effort and pattern, SpO2
  • Cardio-vascular: heart rate, BP, capillary refill time, arrhythmia
  • Fluid status: urine output
  • Skin: colour, rashes, wound assessment

Care and treatment priorities:

Clinician review

  • Blood tests: Lactate level assessment (via blood gas measurement), FBC, blood cultures, CRP, urea and electrolytes
  • Early antibiotics: within 1 hour (if at high (red) risk) or within 3 hours (if at moderate (amber) risk)
  • Fluid status (perfusion):
    • Fluid resuscitation: 20mL/kg of a crystalloid solution over 10-15 minutes
    • Monitor urine output: (catheterise as necessary)
  • Vital signs observations: Regular monitoring and recording of breathing, cardiovascular status, temperature
  • Oxygen delivery: titrate supplemental oxygen to oxygen saturation level to keep patient's SpO2 within 94% to 98% (88% to 92% in patients who have a known COPD)
  • Infection screening: Does the patient have a cough? Leaking wound? Cloudy or smelly urine? Take samples. Ward based urinalysis

This learning resource explores the use of the NICE (2016) guidelines in recognising, assessing and managing sepsis however other scoring systems are available in recognising sepsis. You may want to follow these links further.

Sepsis Six
Daniels R, Nutbeam T, McNamara G, Galvin C. (2011) The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011 Jun;28(6):507-12. Published online in 2010, this tool has provided the basis for the recognition of sepsis. The easy to learn six steps developed still form the basis of managing the patient with sepsis, although the NICE guidelines now include and extend this tool.

Sequential Organ Failure Assessment also known as Sepsis-related Organ Failure Assessment (SOFA)
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–710. This tool provides a way to formally identify sepsis related organ dysfunction, particularly in septic shock. It utilises blood results physiological information, mental state assessment and treatment required by an individual patient to provide a score predicting the severity of organ dysfunction and risk of mortality.

Quick Sequential [sepsis-related] Organ Failure Assessment (QSOFA)
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:762–74. This is a rapid way of identifying potential sepsis. If your patient has any two of the following symptoms, altered mental state, a fast respiratory rate and low blood pressure, then suspect sepsis. This is followed up with developing a score of 1 point each for systolic hypotension (≤100 mmHg); tachypnoea (≥22 per min) or altered mental state. Total=3.

The UK Sepsis Trust This is both a patient and professional website with excellent information and links to tools and further online learning.

Surviving Sepsis Campaign This US website is developed by the Society of Critical Care Medicine. Current UK advice in recognising sepsis from: National Institute for Health and Care Excellence [NICE] (2016) Sepsis: recognition, diagnosis and early management [NG51]

NICE guidelines:
NICE (2014) Pneumonia in Adults: diagnosis and management [CG191]
NICE (2017) Antimicrobial stewardship: changing risk-related behaviours in the general population [NG63]

Other UK guidelines:
Public Health England (2015) Start Smart – Then Focus: Anti-microbial stewardship toolkit for English Hospitals

The team is keen to acknowledge the invaluable support of the following people and organisations:

  • Paula Evans, Sepsis Lead Nurse Sherwood Forest Hospitals NHS Foundation Trust, for her support in the re-design and critiquing of the previous iteration as part of developing the basis for this new resource.
  • Antimicrobial Stewardship colleagues (S. Crusz, T. Hills, S. Bowler and V. Weston), Nottingham University Hospitals NHS Trust, for their support in ensuring correct interpretation of the antimicrobial guidelines.

We would also like to thank the many people who peer-reviewed this resource and who commented so helpfully.

  • Czura, CJ (2011) Merinoff Symposium 2010: Sepsis - Speaking with One Voice Molecular Medicine Jan-Feb; 17(1-2): 2-3
  • NHS England (2015) Improving outcomes for patients with sepsis: A cross-system action plan
  • NHS England/Contracting and Incentives Team (2015) Commissioning for Quality and Innovation (CQUIN) Guidance for 2015/16
  • NHS England/Contracting and Incentives Team (2016) Commissioning for Quality and Innovation (CQUIN) Guidance for 2016/17
  • National Institute for Health and Care Excellence (NICE) (2016) Sepsis: recognition, diagnosis and early management NICE guidelines [NG51]