Risk Tips for Early Detection and Management of Sepsis

Sepsis Detection & Management: Risk Tips for UK Clinicians

As sepsis continues to have a significant impact on patient outcomes and clinical wellbeing, raising awareness of the condition remains vital. At PMP, we support UK clinicians with expert medicolegal guidance alongside our comprehensive medical indemnity insurance, because managing clinical risk and protecting your practice go hand in hand. The updated NICE guidance (March 2024) recommends using National Early Warning Score 2 (NEWS2) for the recognition, diagnosis and early management of suspected sepsis. It includes recommendations on recognition and early assessment, initial treatment, escalating care, finding and controlling the source of infection, early monitoring, information and support, and training and education.

The Sepsis Trust manual has also been revised for 2024. It embraces the 2024 update of the NICE guidelines on sepsis, which includes recommendations from the 2022 Academy of Medical Royal Colleges statement around timing of administration of antimicrobials.

Risk management strategies

1. Provide education and training for all staff on the early detection and management of sepsis. This should include education on the use of the National Early Warning Score 2 (NEWS2) and the UK Sepsis Trust, Sepsis Screening and Action tools.

2. Ensure all clinical staff are aware of the common infections associated with sepsis, such as urinary tract infections, pneumonia, abdominal infections, skin/soft tissue infections and postpartum endometriosis. If investigating or treating maternal sepsis, clinicians should be aware of updated NICE guidance.

3. Highlight to all staff the patient population groups at increased risk for sepsis, such as:

• Infants (under one year of age) and older people (over 75 years of age).
• Patients who have had trauma, surgery or other invasive procedures in the past six weeks.
• Patients on chemotherapy.
• Patients who are immunocompromised due to a co-morbid condition (such as diabetes mellitus, HIV, cirrhosis, sickle cell disease, or asplenia).
• People with any breach of skin integrity (for example, cuts, burns, blisters or skin infections).
• Women who are pregnant, are post-partum or have had a termination of pregnancy or miscarriage in the past six weeks.

NB: this is not a comprehensive list and the National Institute for Health and Care Excellence (NICE) provides further information.

4. Be aware of atypical symptoms in high-risk patients, such as general malaise, agitation or behavioural change. Patients with sepsis may not always present with a high temperature. Indeed, some present with hypothermia.

5. Following a confirmed diagnosis or suspicion of sepsis, institute an action plan as a matter of urgency. Consider using the Sepsis Six care bundle.

6. Ensure appropriate antibiotic use, guided by the suspected focus of infection, in line with local/national prescribing guidelines. Follow evidence-based guidance on the use of antibiotics tailored to cover the likely pathogens. If in doubt, discuss with the microbiology or infectious diseases team. Review the choice of antibiotic after culture and sensitivity results are reported.

7. Depending on the patient’s condition and your competency to safely manage sepsis, you may need to collaborate with other members of the multi-disciplinary team for a specialist opinion.

8. Ensure that you keep accurate and clear notes in the patient’s medical records, including all negative and positive findings. Thorough documentation is your strongest defence in the event of a complaint or claim, and a prerequisite for any successful medical indemnity claim. 

9. Managing a patient with sepsis can be a stressful experience for all those involved in their care. It is important that the lead clinician provides effective leadership and keeps staff up-to-date with the patient’s care plan and any changes in their condition or treatment. Make sure adequate communication channels are in place, including robust handover procedures, so that staff can update colleagues regarding the condition of the patient and relay any concerns.

10. Maintain open and honest communication with patients and their families throughout this challenging episode of care.

If you are involved in a patient safety incident, receive a complaint, or become aware of a claim or potential claim, you must complete a claims notification form as soon as possible so our claims team can review the matter promptly.

If you require advice or guidance relating to the situation, please contact the PMP medicolegal helpline. Our experienced team is available 24 hours a day, seven days a week to provide immediate support and assistance.