Clinical update

Sepsis guidance: what nurses are now required to do

Compliance has become mandatory for all NHS trusts in England  

Compliance has become mandatory for all NHS trusts in England  


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Essential information

Sepsis, which claims 52,000 lives a year in the UK, occurs when the body has an abnormal immune response to an infection, which causes organs to start failing. Sepsis can be triggered by any infection, but most commonly it occurs in response to bacterial infections of the lungs, urinary tract, abdominal organs or skin and soft tissues. It can be difficult to spot because symptoms can also indicate less serious conditions, but early treatment is vital.

What’s new

Healthcare staff must alert senior doctors if patients with suspected sepsis do not respond to treatment within one hour under guidance that hospitals must now follow.

All NHS trusts in England are now contractually obliged to comply in full with the sepsis advice in a bid to improve accountability. It is part of the NHS Long Term Plan, which sets out priorities for the health service in England over the next decade.

The sepsis guidance, written by organisations including the Royal College of Physicians, the UK Sepsis Trust and NHS England, was initially published in 2017, and will now be part of the NHS standard contract.

The UK Sepsis Trust says this means hospitals that do not meet the requirements could face financial penalties.

The guidance requires staff to look at an early stage for signs of sepsis in people coming into the emergency department and to flag cases when patients suspected as having the condition are not responding to treatment.

Nurses and doctors must take notice of family concerns, particularly if they report significant change in behaviour.

Expert comment

Georgina Taylor, UK Sepsis Trust head of training and education says: ‘All nurses must understand that treating sepsis is an emergency, and as important as treating a patient for a heart attack or a stroke. We welcome the focus on sepsis in the NHS Long Term Plan. The key aspects are the emphasis on importance of consistent early identification and treatment of sepsis, and stronger accountability for NHS organisations that fail to recognise and treat patients with sepsis.

‘Early medical consultant intervention for those with suspected sepsis will allow for a clear plan for review and action for those who do not respond to intravenous antibiotics with or without a fluid bolus within an hour. All nurses need to know the signs and signals to look out for that could indicate sepsis, and know what to do when it is suspected, as fast action is needed.’

RCNi sepsis resource collection

    Implications for nurses

    • Consider the possibility of sepsis when assessing people with clinical deterioration due to likely infection, or in those who are acutely unwell with no clear cause
    • Be aware that risk factors include being very young or old, being immunosuppressed, having gestational diabetes, and invasive procedures or surgery
    • Pay attention to important elements of clinical history, including non-specific symptoms and concern expressed by relatives or carers about acute changes in behaviour
    • The guidance strongly supports the use of the National Early Warning Score tool for adults in hospitals, mental health hospitals, ambulances and prison healthcare
    • Patients who do not respond to antibiotic treatment within an hour should be seen by or discussed with a consultant urgently

    Find out more


    Erin Dean is a health journalist

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