Adult Sepsis Screening Tool

Step 1 of 4

Could the patient have a medical presentation or could this be an infection?

Consider the clinical context. If clearly a trauma/surgical emergency unrelated to infection, this pathway may not apply.

🚨 SEPSIS — High Risk

This patient meets criteria for high-risk sepsis. Immediate action required — do not delay.

Alert receiving team immediately (pre-alert if transporting)
Initiate IV/IO access en route if appropriate
Administer O₂ to maintain SpO₂ 94–98% (88–92% if COPD risk)
Fluid resuscitation: 500ml 0.9% NaCl bolus if hypotensive (reassess)
Obtain blood glucose
Document time of recognition — sepsis clock starts now
Target hospital with sepsis capability

⚠️ SEPSIS — Consider Screening

NEWS2 score or risk factors suggest sepsis screening is appropriate. Assess for red flags and escalate if any identified.

Complete full clinical assessment
Reassess NEWS2 — is the score rising?
Check for red flags (see panel below)
Consider early transport and pre-alert
Consider empirical antibiotics per local protocol if red flags develop
Document time of recognition

✓ Low Risk — Continue Assessment

Patient does not currently meet sepsis screening criteria. Reassess regularly — sepsis can evolve rapidly.

Continue standard assessment and management
Reassess NEWS2 regularly (every 15–30 mins if unwell)
If condition deteriorates, restart this pathway
Consider alternative diagnoses
Document findings and clinical reasoning

Pathway Not Applicable

This sepsis screening pathway is for patients with suspected infection. Manage the presenting condition per the appropriate clinical pathway. If clinical picture changes and infection becomes suspected, restart this tool.

Glossary of Terms

Age ≥75 +

The pre-disposition to sepsis due to conditions including multi-morbidity, repeated infections, functional limitations, a lower baseline and a higher index of suspicion during assessment. For the aging process often sees the clinical decline of the inflammatory response, making it harder for the immune system to respond adequately to infections, and ageing increases the risk of a sudden deterioration, morbidity in the ≥75 age cohort is high.

Chemotherapy ≤6 weeks +

Cancer patients are particularly susceptible to developing sepsis. A study published in 2016 found that sepsis in oncology patients was more likely to be hospitalised with sepsis than the general population. The study also found that cancer sepsis caused around 8.5 percent of cancer-related deaths. As immunocompromised patients may need careful consideration of a high risk aetiology and tailored antibiotic therapy, the administration of treatment should also be considered with obstetrics, post-splenectomy and any patients treated with corticosteroids/immunosuppressants.

Post-partum +

Between 2011 and 2013 infections or sepsis claimed 12.7% of pregnancy-related deaths in the UK. Pregnancy-associated sepsis requires early detection, accurate diagnosis, and aggressive treatment. A 2016 study (Shields 2016) reported that "Sepsis is currently the leading cause of direct maternal death in the UK."

Lymphoedema in situ +

Leg cellulitis/skin infections must be considered due to the simple fact they provide direct access for bacteria to enter the body. A higher index of suspicion with any indwelling line etc.

Surgical Procedure ≤6 weeks +

Surgery is a procedure that allows your body in many ways aside from the actual reason for the operation. Any type of surgery exposes your body to infection and a fair number of complications, some of which could develop into sepsis. It would assume this wound site for signs of inflammation.

IV Drug Use +

A high index of suspicion is required for this patient group due to non-sterile injection techniques and a potential wound/vein site.

Previous diagnosis of sepsis +

Sepsis is an independent predictor of recurrent infection, hospitalisation for infectious causes, and death in the post-sepsis period. A patient has a higher chance of becoming septic if they have previously had a sepsis diagnosis.

Known antibiotic-resistant bugs +

This patient group will have a much higher mortality due to the antibiotic resistance — aggressive treatment is warranted.

Clinical Disclaimer: This tool is an interactive aid based on NHS Adult Sepsis Screening guidelines (NEWS2). It does not replace clinical judgement. Always apply local protocols, NWAS/JRCALC guidelines, and individual patient assessment. If in doubt, treat as sepsis and escalate.