Clinical update

Sepsis Six update: the important changes every nurse needs to know about

UK Sepsis Trust reviews first step in its screening and management tool

UK Sepsis Trust reviews first step in its screening and management tool

Blood infection sepsis
Picture: Dennis Kunkel Microscopy/Science Photo Library

Essential info

Five people die as a result of sepsis every hour in the UK, and a quarter of survivors are left with permanent, life-changing after-effects, according to the UK Sepsis Trust.

The potentially life-threatening condition, which is caused by infection, can be difficult to spot as symptoms are similar to many other common conditions. However, if detected and treated early, outcomes are positive.

What’s new

The screening and management tool the Sepsis Six has been updated. The tool, which sets out the six actions that should be taken within one hour in suspected sepsis cases, now lists as its first step that patients should be seen by a senior clinician.

The emphasis on rapid senior clinical input is the most significant update since the tool was developed by the UK Sepsis Trust in 2005.

If a patient has a red flag (one of several symptoms or conditions listed on the tool) after one hour, a consultant should be called.

National Institute for Health and Care Excellence (NICE) guidance also advises that a senior clinical decision maker see patients with high risk of severe illness or death from suspected sepsis within one hour.

RCNi’s sepsis resource collection

Signs and symptoms

Symptoms of sepsis include a non-blanching rash or mottled skin, extreme shivering or muscle pain, not passing urine, confusion and extreme breathlessness.

Healthcare professionals should consider sepsis if the patient looks ill or has any signs of infection, if a relative or carer is unusually concerned about their condition, or their sysmptoms trigger an early warning score.

A National Early Warning Score (NEWS 2) over five should prompt a sepsis review, the UK Sepsis Trust says.

Causes and risk factors

Sepsis is the immune system’s overreaction to an infection or injury.

For reasons not understood, the body starts to attack the organs and tissues, which can lead to organ failure.

Sepsis can be triggered by any infection, but most commonly occurs in response to bacterial infections of the lungs, urinary tract, abdominal organs or skin and soft tissues. 

Risk factors include being aged 75 or over, impaired immunity, recent trauma, surgery or invasive procedure, indwelling lines, intravenous drug use or broken skin.

How you can help your patient

Start the Sepsis Six for any patient presenting with one or more red flag.

The new Sepsis Six is: 

  1. Ensure senior clinician attends
  2. Oxygen if required Start if O2 saturations are less than 92% – aim for O2 saturations of 94-98%. If at risk of hypercarbia aim for saturations of 88-92%.
  3. Obtain IV access, take bloods Blood cultures, blood glucose, lactate, FBC, urea and electrolytes (U&Es), C-reactive protein (CRP) and clotting lumbar puncture if indicated.
  4. Give IV antibiotics Maximum dose broad spectrum therapy. Consider local policy, allergy status, antiviral.
  5. Give IV fluids Give fluid bolus of 20mL/kg if aged under 16, 500mL if 16 or over. NICE recommends using lactate to guide further fluid therapy.
  6. Monitor Use NEWS-2. Measure urinary output: this may require a urinary catheter. Repeat lactate at least once per hour if initial lactate is elevated or if clinical condition changes.

Expert comment

Georgina Taylor, lecturer in adult nursing at the University of Wolverhampton and clinical educator for the UK Sepsis Trust, says:

‘This update states the importance of early senior clinical involvement. We’ve made good progress in improving education around sepsis, and the introduction of national early warning scores, especially NEWS-2, in acute trusts maintains safety.

'We are getting more positive outcomes in the treatment of sepsis, but we are still not escalating early enough when sepsis is suspected.

‘Escalation to senior clinical staff is critical for early intervention to be successful. The UK Sepsis Trust continues to offer educational packages for clinical staff to upskill and to recognise patients with sepsis.’


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