or who have clinical observations outside normal limits. Sepsis Screening & Action Tool To be applied to all non-pregnant patients over 12 years who have suspected infection, for whom staff or relatives are concerned, or who have clinical observations outside normal limits. Patient details (affix label): Date/Time: Staff member completing form: Name (print): Designation: Signature: ……………………………... ……………………………… ………………………………………… Important: Is an end of life pathway in place/ is escalation clinically inappropriate? Yes Initials Stop pathway 1. Is individual NEWS 3 or overall ≥5? 2. Is there clinical concern? Tick Low risk of sepsis Use standard protocols, review if deteriorates N Y N 2. Could this be due to an infection? Yes, but source unclear at present Pneumonia Urinary Tract Infection Cellulitis/ septic arthritis/ infected wound Device-related infection Meningitis Other (specify: ………………………..) Abdominal pain/distension–refer for senior surgical review 4. Any Amber Flag criteria? Relatives concerned about mental status Acute deterioration in functional ability Immunosuppressed Trauma, surgery or procedure in last 6 weeks Clinical signs of wound, device or skin infection Respiratory Rate 21-24 or breathing hard Heart Rate 111-130 or new arrhythmia Systolic BP 91-100 mmHg Not passed urine in last 12-18 hours Temperature < 36OC Rigors Tick Tick N Y 3. Is any ONE red flag present? Systolic BP ≤ 90 mmHg (or drop >40 from normal) Lactate ≥ 2 mmol/l Respiratory Rate (RR)> 25 per minute Heart Rate (HR) > 130 per minute Responds only to voice, pain or is unresponsive Needs oxygen to keep SpO2 ≥92% (88% in COPD) Non-blanching rash, mottled/ ashen/ cyanotic Oliguria (from history or less than 0.5 ml/kg/hr) Recent chemotherapy (6 weeks) Tick Y Send bloods To include FBC, U&Es, CRP, LFTs, clotting Contact senior doctor to review USE SBAR! Must review results within 1 hour Has clinician attended? Time complete Initials N Is AKI present? (tick one) YES NO Clinician to make antimicrobial Prescribing decision within 3h Time complete Initials Y Y Red Flag Sepsis. Start Sepsis 6 pathway NOW (see overleaf) This is time critical, immediate action is required. Dr Name / Signature: Time Zero: Sepsis Six and Red Flag Sepsis are copyright to and intellectual property of the UK Sepsis Trust, registered charity no. 1158843. sepsistrust.org

Sepsis Six Pathway 1. Administer oxygen 2. Take blood cultures To be applied to all patients over 12 years of age with suspected or confirmed Red Flag Sepsis Make a treatment escalation plan and decide on CPR status Patient has Red Flag Sepsis Senior doctor & CCOT/ART* informed? Time zero Initials Action (complete ALL within 1 hour) Time complete Signature Comments 1. Administer oxygen Aim to keep saturations > 94% (88-92% if at risk of CO2 retention e.g. COPD) 2. Take blood cultures From *PICC/Hickman/central line too Remember to take blood cultures using an aseptic non touch technique Septic screen – sputum, urine & swabs 3. Give IV antibiotics According to Trust protocol Consider allergies and MRSA history prior to administration 4. Give IV fluids As per hospital protocol/NICE guidelines Titrate fluid boluses depending on lactate levels 5. Check serial lactates 6. Measure urine output Ensure fluid balance chart commenced & completed hourly May require urinary catheter Not applicable- initial lactate <2 If after delivering the Sepsis Six, patient still has: Systolic B.P <90 mmHg Reduced level of consciousness despite resuscitation Respiratory rate over 25 breaths per minute Lactate not reducing Or if patient is clearly critically ill at any time Then Call Cons and CCOT/Acute Response team See Intranet for guidelines on sepsis management and antimicrobial policy – microguide. *Remember to take blood cultures peripherally and from all lumens and label correctly as per policy (see blood culture policy on intranet) *CCOT- Critical Care Outreach Team/ART- Acute Response Team For more copies of this document please contact Reprographics on 3778 and Quote: Print No. A4 Colour 10 August 2016 Sepsis Six and Red Flag Sepsis are copyright to and intellectual property of the UK Sepsis Trust, registered charity no. 1158843. sepsistrust.org