Quality statement 3: Intravenous fluids

Quality statement

People with suspected sepsis in acute hospital settings who need treatment to restore cardiovascular stability have an intravenous fluid bolus within 1 hour of risk being stratified.

Rationale

Early intervention with intravenous fluids is vital for managing sepsis. It can help to reverse septic shock and to restore cardiovascular stability for people who are at high risk of severe illness or death. Intravenous fluids improve oxygen delivery to organs and so reduce long-term disability associated with poor tissue perfusion.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that people with suspected sepsis in acute hospital settings who need treatment to restore cardiovascular stability have an intravenous fluid bolus within 1 hour of risk being stratified.

Data source: Local data collection, for example, using hospital board reports.

b) Evidence of local arrangements and written clinical protocols to ensure that people with suspected sepsis in acute hospital settings have their lactate levels recorded.

Data source: Local data collection, for example, healthcare records.

Process

a) Proportion of adults and young people age 12 years and over with suspected sepsis in acute hospital settings and systolic blood pressure less than 90 mmHg who receive an intravenous fluid bolus within 1 hour of blood pressure being measured as less than 90 mmHg.

Numerator – the number in the denominator who receive an intravenous fluid bolus within 1 hour of blood pressure being measured as less than 90 mmHg.

Denominator – the number of adults and young people age 12 years and over with suspected sepsis in acute hospital settings and systolic blood pressure less than 90 mmHg.

Data source: Local data collection.

b) Proportion of people with suspected sepsis in acute hospital settings, at least 1 criteria indicating high risk of severe illness or death from sepsis, and with lactate over 2 mmol/litre, who receive an intravenous fluid bolus within 1 hour of risk being stratified.

Numerator – the number in the denominator who receive an intravenous fluid bolus within 1 hour of risk being stratified.

Denominator – the number of people with suspected sepsis in acute hospital settings, at least 1 criteria indicating high risk of severe illness or death from sepsis, and with lactate over 2 mmol/litre.

Data source: Local data collection.

Outcome

a) Rates of cardiovascular stability in people with suspected sepsis.

Data source: Local data collection, for example, using Hospital Episode Statistics.

b) Rates of 28-day all-cause mortality in people with sepsis.

Data source: Local data collection, for example, using Hospital Episode Statistics and Office for National Statistics mortality database.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that systems are in place for people with suspected sepsis who need treatment to restore cardiovascular stability, to have an intravenous fluid bolus within 1 hour of need for treatment being identified. They should also ensure that there are systems in place for people with suspected sepsis to have lactate levels taken and recorded.

Healthcare professionals (such as healthcare professionals working in emergency departments) give an intravenous fluid bolus to people who need treatment to restore cardiovascular stability, within 1 hour of need for treatment being identified. They measure and record lactate levels of people who have suspected sepsis.

Commissioners (such as clinical commissioning groups) ensure that they commission services in which people who need treatment to restore cardiovascular stability have an intravenous fluid bolus within 1 hour of need for treatment being identified. The services they commission should take and record lactate levels in people with suspected sepsis.

People with symptoms that suggest life-threating illness from sepsis have extra fluids in hospital through a drip or injection, no more than an hour after they have been diagnosed as being at high risk.

Source guidance

Sepsis: recognition, diagnosis and early management (2016) NICE guideline NG51, recommendations 1.6.2, 1.6.3, 1.6.17, 1.6.18, 1.6.32 and 1.6.33

Definitions of terms used in this quality statement

People with suspected sepsis who need treatment to restore cardiovascular stability

This includes the following groups:

  • people with suspected sepsis and at least 1 of the criteria indicating high risk of severe illness or death, and with lactate over 2 mmol/litre

  • adults and young people 12 years and over with suspected sepsis and systolic blood pressure less than 90 mmHg.

[Adapted from NICE's guideline on sepsis, recommendation 1.6.2, 1.6.3, 1.6.17, 1.6.18, 1.6.32 and 1.6.33]

Suspected sepsis

Suspected sepsis is used to indicate people who might have sepsis and require face-to-face assessment to determine whether they need urgent intervention.

Symptoms of sepsis can include, but are not limited to:

  • high body temperature or low body temperature

  • fast heartbeat/breathing

  • feeling dizzy or faint/loss of consciousness

  • a change in mental state, for example, confusion or disorientation

  • diarrhoea/nausea and vomiting

  • slurred speech

  • severe muscle pain

  • breathlessness

  • reduced urine production

  • cold, clammy and pale or mottled skin.

People with sepsis may have non-specific, non-localised presentations, for example, they may feel very unwell, and may not have a high temperature.

[NICE's guideline on sepsis and expert opinion]