In-Patient Sepsis Algorithm

(Exercising Clinical Judgment)

Sepsis Screen
NEWS ≥ 4 (or ≥ 5 on oxygen) and
suspicion of infection
Check for 1, 2 or 3
Screening and Medical Review – 1 hour

At risk of neutropenia, e.g. Systemic inflammatory

Clinical evidence of new
1 on chemotherapy/ 2 onset organ dysfunction
3 response (≥2 SIRS)
radiotherapy plus ≥ 1 co-morbidity

Actions Actions
Screen Positive Screen Negative

1. Escalate as per NEWS protocol

1. Follow usual management pathway
2. Place sepsis form with
2. Usual NEWS escalation protocol
documentation

Medical Review
History & examinations supports infection as likely cause of presentation
This is Time Zero

Urgent Anaesthetic/
Complete Give antimicrobials as per
By 1 hour

local antimicrobial guideline Critical Care review for:

Fluid resistant Shock,
Sepsis 6 Bundle Assess for
source control
Respiratory failure,
Purpuric rash

Assess patient’s clinical status

Review blood tests and other

Escalate for source control
investigations Review differential
Repeat lactate if 1st abnormal or Critical Care
diagnosis
as indicated
By 3 hours

Continue fluid resuscitation as indicated

Infection and organ Infection no organ Aetiology unclear +

dysfunction – dysfunction Organ dysfunction Non-infective aetiology
This is SEPSIS
This is INFECTION Continue IV antimicrobials STOP antimicrobials
On pressors –
This is SEPTIC SHOCK Usual treatment pathway until senior review

Complete and sign the Sepsis Form

Assess clinical, haematological and biochemical response to treatment

In-Patient Sepsis Algorithm Short Version - 27/08/2018
Daily Review

Follow local antimicrobial guideline

Deteriorating
Improving No change Urgent senior input.
Follow “Start Smart then Focus” Review diagnosis and treatment, Review diagnosis and treatment.
policy check for source control Consider microbiology review.
Consider Critical Care review.