Suspected sepsis in over 16s

  • Quality standard
  • QS213
  • Published: 
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Quality statement 2: Assessment outside acute settings

Quality statement

People aged 16 or over with suspected sepsis outside acute settings are assessed face-to-face using a structured set of observations, which could include those used to calculate an early warning score, 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. Using a structured set of observations for assessing physiological symptoms should ensure that people who are at risk of severe illness or death from sepsis receive timely and appropriate treatment. This could include a structured set of observations used to calculate a suitable early warning score.

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 suspected sepsis outside acute settings who were assessed face-to-face using a structured set of observations to stratify risk of severe illness or death.

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

Denominator – the number of people aged 16 or over with suspected sepsis outside acute settings.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as primary, ambulatory and custodial care services) ensure that written protocols are in place for people aged 16 or over with suspected sepsis to be assessed face-to-face using a structured set of observations, which could include those used to calculate an early warning score, to identify risk of severe illness or death.

Healthcare professionals (such as GPs and nurse practitioners) consider sepsis if a person presents with signs or symptoms that indicate possible infection. They assess people aged 16 or over with suspected sepsis face-to-face using a structured set of observations, which could include those used to calculate an early warning score, to identify risk of severe illness or death. Healthcare professionals are aware of the criteria that indicate when to refer people for emergency medical care.

Commissioners ensure that primary, ambulatory and custodial care services carry out face-to-face assessments using a structured set of observations, which could include those used to calculate an early warning score, to identify risk of severe illness or death for people aged 16 or over presenting with symptoms that suggest sepsis outside acute settings.

People aged 16 or over with symptoms that suggest sepsis who are not in hospital have a structured face-to-face assessment 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]

Structured set of observations

A structured set of observations should be used to identify risk of severe illness or death from sepsis. This could include those used to calculate an early warning score and should be based on the observations detailed in the initial assessment and examination in the NICE guideline. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.1.7 and section 1.3]

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.