This is a new guideline from NICE on the detection and management of sepsis. None of this is likely to be new, but it is worth looking through. I think the main reason is, sadly, from a medico-legal point of view. I guess if we have not documented obs that have been clearly laid out, or ignored listed high-risk features, we will be at higher medico-legal risk. The good news is that there are quite easy to follow guidelines on what to do and what constitutes high- and medium-risk. Maybe worth printing out…
What assessment to carry out in patients with suspected sepsis:
- Temperature
- Heart Rate
- Respiratory Rate
- Level of consciousness
- Oxygen saturation (young people and adults)
- Capillary Refill (children under 12)
- Appearance (eg skin mottling / lip colour etc)
- Amount of urine passed in last 18 hrs
- Blood Pressure
- In all over 12s.
- 5 to 11-year-olds with suspected sepsis, if you have an appropriately sized cuff available and if its measurement doesn’t cause a delay in assessment or treatment.
- Under 5s if heart rate or capillary refill is abnormal.
High, moderate and low-risk features to watch out for:
There are too many to document here. NICE have created handy single page tables with the features. Maybe worth printing out and referring to if needed…
- Assessment in the over 12s.
- Assessment in 5 to 12-year-olds.
- Assessment in the under 5s.
Information about specific features
Fever
Do not use fever alone, or its absence to rule out or rule in sepsis.