Suspected sepsis in over 16s

  • Quality standard
  • QS213
  • Published: 
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Quality statement 4: Intravenous fluids

Quality statement

People aged 16 or over at high risk of severe illness or death from sepsis in acute hospital settings have an intravenous fluid bolus within 1 hour of risk being identified, unless contraindicated.

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

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 at high risk of severe illness or death from sepsis in an acute hospital setting who receive an intravenous fluid bolus within 1 hour of risk being identified.

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

Denominator – the number of people aged 16 or over at high risk of severe illness or death from sepsis in an acute hospital setting.

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 treatment with intravenous bolus. Given that an intravenous fluid bolus may be contraindicated, achievement levels should be agreed locally.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that systems are in place for people aged 16 or over who are at high risk of severe illness or death from sepsis to have an intravenous fluid bolus within 1 hour of risk being identified.

Healthcare professionals (such as healthcare professionals working in emergency departments) give an intravenous fluid bolus to people aged 16 or over who are at high risk of severe illness or death from sepsis, within 1 hour of risk being identified.

Commissioners ensure that they commission services in which people aged 16 or over who are at high risk of severe illness or death from sepsis have an intravenous fluid bolus within 1 hour of risk being identified.

People aged 16 or over with symptoms that suggest life-threatening illness from sepsis have fluids in hospital through a drip or injection, no more than an hour after they have been identified as being at high risk.

Definitions of terms used in this quality statement

High risk of severe illness or death from sepsis

In acute hospital settings, people aged 16 or over (who are not and have not recently been pregnant) are at high risk of severe illness or death from sepsis if:

  • they have suspected or confirmed infection and a NEWS2 score of 7 or above.

  • they have suspected or confirmed infection, a NEWS2 score below 7, and:

    • a single parameter contributes 3 points to their NEWS2 score and a medical review has confirmed that they are at high risk or

    • there are any other clinical reasons for concern.

Clinical judgement should be used to interpret the NEWS2 score. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.8.1]

Within 1 hour of risk being identified

Within 1 hour of calculation of the person's NEWS2 score on initial assessment in the emergency department or on ward deterioration. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.8.3]

Unless contraindicated

Providing there are no contraindications such as cardiac or renal failure. [NICE's guideline on suspected sepsis in people aged 16 or over, rationale and impact section on when to give fluids]