Quality standard

Quality statement 1: Assessment

Quality statement 1: Assessment

Quality statement

People with suspected sepsis are assessed using a structured set of observations to stratify risk of severe illness or death.

Rationale

People with suspected sepsis require face-to-face assessment to determine whether they need urgent intervention. Using a structured set of observations for assessing physiological symptoms should ensure that people at risk of severe illness or death from sepsis receive timely and appropriate treatment.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that a structured set of observations are used to stratify risk of severe illness or death from sepsis.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations. Services can consider using an early warning score (such as the Royal College of Physicians' National Early Warning Score) to inform local arrangements and written clinical protocols.

Process

a) Proportion of people with sepsis in acute hospital settings who were assessed using a structured set of observations to stratify risk of severe illness or death from sepsis.

Numerator – the number in the denominator who were assessed using a structured set of observations to stratify risk of severe illness or death from sepsis.

Denominator – the number of people diagnosed with sepsis in acute hospital settings.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, using NHS Digital Hospital Episode Statistics.

b) Proportion of people with sepsis who were referred to an acute hospital setting from primary or ambulatory care settings who were assessed using a structured set of observations to stratify risk of severe illness or death from sepsis.

Numerator – the number in the denominator who were assessed using a structured set of observations to stratify risk of severe illness or death from sepsis.

Denominator – the number of people with sepsis referred to an acute hospital setting from primary or ambulatory care settings.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Rates of admission to critical care for people with sepsis.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, using NHS Digital Hospital Episode Statistics.

b) Rates of in-hospital mortality for people with sepsis.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, using NHS Digital Hospital Episode Statistics and Office for National Statistics primary care mortality database.

What the quality statement means for different audiences

Service providers (such as primary, ambulatory and secondary care services) ensure that written protocols are in place on the use of structured sets of observations to stratify risk of severe illness or death (such as an early warning score) when people are suspected to have sepsis.

Healthcare professionals (such as GPs, paramedics and healthcare professionals working in emergency departments) consider sepsis if a person presents with signs or symptoms that indicate possible infection. They should use a structured set of observations to stratify risk of severe illness or death in people with suspected sepsis. Healthcare professionals outside acute healthcare settings should also be aware of the criteria that indicate when to refer people for emergency medical care.

Commissioners ensure that primary, ambulatory and secondary care services demonstrate the use of structured sets of observations for people presenting with symptoms that suggest sepsis. They should also monitor performance against the national CQUIN on the timely identification of sepsis.

People with symptoms that suggest sepsis are assessed to see whether they have a high risk of life-threatening illness from sepsis, and if urgent treatment or more checks are needed.

Definitions of terms used in this quality statement

Structured set of observations

Everyone with suspected sepsis should have the following assessed:

  • temperature

  • heart rate

  • respiratory rate

  • level of consciousness

  • oxygen saturation.

Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.

Everyone with suspected sepsis should also be examined for:

  • mottled or ashen appearance

  • cyanosis of the skin, lips or tongue

  • non-blanching rash of the skin

  • any breach of skin integrity (for example, cuts, burns or skin infections)

  • any rash indicating potential infection.

The person, parent or carer should also be asked about the frequency of urination in the past 18 hours. [NICE's guideline on sepsis, recommendations 1.3.7, 1.3.8 and 1.4.2]

Children under 12 years should have capillary refill assessed. [NICE's guideline on sepsis, recommendations 1.3.1 and 1.3.2]

Blood pressure should be measured:

  • in adults and young people over 12 years

  • in children aged 5 to 11 years if facilities, including a cuff of correct size, are available

  • in children under 5 years if heart rate or capillary refill time are abnormal and facilities to measure blood pressure, including a cuff of correct size, are available.

[NICE's guideline on sepsis, recommendations 1.3.1, 1.3.3 and 1.3.4]

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]

Equality and diversity considerations

People with suspected sepsis should be assessed with extra care if they or their families or carers cannot give a good history of their signs and symptoms (for example, people with English as a second language or people with communication problems). People should have access to an interpreter or advocate if needed.