Suspected sepsis in over 16s

  • Quality standard
  • QS213
  • Published: 
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Quality statement 1: Assessment in acute settings

Quality statement

People aged 16 or over with suspected sepsis in acute hospital, acute mental health or ambulance settings are assessed face-to face using the national early warning score (NEWS2) to identify risk of severe illness or death.

Rationale

For people with suspected sepsis, a face-to-face assessment is needed to determine whether their condition needs urgent intervention. For people aged 16 or over who are not and have not recently been pregnant using clinical judgement alongside a NEWS2 score can help identify the risk of severe illness or death from sepsis and ensure 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.

Process

Proportion of people aged 16 or over with sepsis in acute settings (who are not and have not recently been pregnant) whose risk of severe illness or death was assessed using NEWS2.

Numerator – the number in the denominator whose risk of severe illness or death was assessed using NEWS2.

Denominator – the number of people aged 16 or over diagnosed with sepsis in acute settings (who are not and have not recently been pregnant).

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The Emergency Care Data Set includes data on assessment tools, including NEWS2, and diagnosis.

What the quality statement means for different audiences

Service providers (such as secondary care, mental health and ambulance services) ensure that written protocols are in place on the use of NEWS2 to assess risk of severe illness or death in people with suspected sepsis aged 16 or over, who are not and have not recently been pregnant, in acute settings.

Healthcare professionals (such as paramedics and healthcare professionals working in emergency departments and acute mental health services) consider sepsis if a person presents with signs or symptoms that indicate possible infection. They should use NEWS2 to assess risk of severe illness or death in people with suspected sepsis aged 16 or over, who are not and have not recently been pregnant, in acute settings.

Commissioners ensure that secondary care, mental health and ambulance services demonstrate the use of NEWS2 to assess risk of severe illness or death in people aged 16 or over, who are not and have not recently been pregnant, presenting with symptoms that suggest sepsis.

People aged 16 or over with symptoms that suggest sepsis in hospital or emergency care (who are not and have not recently been pregnant) are assessed using a tool called NEWS2 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

Suspected sepsis

Suspected sepsis is used when people might have sepsis and their condition needs a face-to-face assessment and consideration of urgent intervention.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. Symptoms of sepsis can include, but are not limited to:

  • high body temperature or low body temperature

  • fast heartbeat, fast breathing

  • feeling dizzy or faint, losing 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 suspected sepsis in people aged 16 or over, recommendation 1.1.2, terms used in this guideline and expert opinion]

Recently pregnant

Someone is considered to have recently been pregnant:

  • in the 24 hours following a termination of pregnancy or miscarriage

  • for 4 weeks after giving birth.

Clinical judgement is needed after miscarriage (particularly in the second trimester) or termination (particularly in the second or third trimester), because it is not clear how quickly people's physiology returns to pre-pregnancy levels in these situations. [NICE's guideline on suspected sepsis in people aged 16 or over, terms used in this guideline]

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 difficulties such as neurodiversity, cognitive impairment, learning difficulties, severe mental health conditions or brain injury). People should have access to an interpreter or advocate if needed. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.1.4 and expert opinion]

Healthcare professionals should 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.